Premier Scholars Program Form | North Central College

Personal Information

First Name:

Last Name:

Street Address:

City:

State:

Zip Code:

Home Phone Number:

Cell Phone Number:

Email Address:

Gender:

Female

Male

First Term at North Central:

Anticipated Major:

Career Aspiration:

Name of High School:

Are you planning on participating in any extra-curricular activities or athletic teams at North Central? If so, which ones?:

Please list any food allergies, dietary needs or other accommodations needed during the program:

Are you interested in staying on the Premier residence hall floor during the school year? if not, why?:

Please indicate your t-shirt size:

Please answer the following questions:

How do you think you would benefit from participating in the Premier Scholars Program?:

What type of challenges have you had to overcome in your life thus far?:

What do you hope to accomplish (career/life goals) after you complete college?:

Please explain any possible schedule conflicts between August 30 and September 9 which might interfere with your attendance such as family vacations, Labor Day activities, religious obligations, sporting events, etc.:

Is there anything else you would like the Premier Scholars Program staff to know about you?: