Clayton State University Honors Program

Honors Program Application Form

GENERAL INFORMATION
First Name
Last Name
MI
Address
City State Zip
Phone		( )
LakerID#
Email:
REFERENCES
1.	Name
	Title
	Address
	Phone
2.	Name
	Title
	Address
	Phone
3.	Name
	Title
	Address
	Phone
COLLEGE INFORMATION
What is your intended major at CSU?
How many credit hours have you completed?
What is your GPA?
Are you a current CSU student or a new transfer student?		Current CSU Student New Transfer Student
Transfer Student Information (skip if current CSU student)
When did you apply to CSU?
What college did you last attend?
Were you in the Honors Program?		Yes No
SCHOOL AND COMMUNITY ACTIVITIES
Please indicate school & community activities; your role, office, etc.; and year:
1.
2.
3.
4.
5.
ESSAY
Why do you want to be in the Honors Program at Clayton State University? Be sure to address the following points: (a) describe what you can contribute to the Clayton State University Honors Program (b) explain how you think the program will benefit you.