Dear Mr. Cuny,
E
September 6, 2012
Thank you for submitting a General Freshman Admission application
PL
to CUNY for the Fall 2013 semester.
M
Please review the following page to determine if additional steps are
needed to complete your application. Once your application is
complete, you will receive notification from each college to which
you have applied. For updates on the status of your application,
please return to the CUNY Portal with your login information and visit
your Application Status page.
SA
We are pleased that you have considered CUNY and look forward to
becoming a part of your academic future.
Sincerely,
Richard P. Alvarez
University Director of Admission
Next Steps to Completing Your Application
for Admission to CUNY
INSTRUCTIONS:
Please review this
page to determine if
additional steps are
required to complete
your application.
Step 1: Pay Application Fee
All applicants are required to pay an application fee. We are unable to evaluate your application for admission until
the fee is received. For confirmation that your application fee has been received or to view payment options, please
visit your Application Status page.
Step 2: Submit Academic Records
E
B. Home-Schooled Students: New York State residents who are home-schooled must submit a transcript outlining
all completed course work with grades earned. Students must also submit a letter from the superintendent of their
school district confirming that all high school graduation requirements of the district have been met through homeschooling. If students cannot obtain the letter from the high school district, they must obtain a GED and send an
official copy of the results and diploma to UAPC.
SA
When possible, please
send all documents
together in a single
envelope.
New York City Public School Students: If you have provided your OSIS number in Section 2 of the
application, we will access your New York City Public High School transcript from our files once your
application fee has been received. You only need to send a paper transcript if you have previously
attended a high school that is not a New York City Public High School. Visit our OSIS FAQs and
Definition page for more information.
PL
General Freshman
Admission
CUNY/UAPC
P.O. Box 350136
Brooklyn, NY
11235-0001
A. High School Students: An official copy of your high school transcript is required. You may wish to print the High
School Request Letter included in this Application Summary Package and mail it directly to your high school.
M
MAIL SUPPORTING
DOCUMENTS TO:
Please make sure to
affix proper postage.
ADMISSION STATUS:
To receive updates
on the status of your
application, return to
the CUNY Portal with
your login information
and visit your
Application Status
page.
Out-of-state residents who are home-schooled must submit a state-issued diploma. If students have not obtained a
state-issued diploma, they must obtain their GED and send an official copy of the results and diploma to UAPC.
C. GED Diploma Recipients: If you have received your General Educational Development (GED) diploma from
New York State, mail a photocopy of the original diploma along with your GED test scores to UAPC. You may obtain
a copy from the New York State Education Department High School Equivalency Testing Program, PO Box 7348,
Albany, New York, 12224-0348. If you received your GED diploma in a state outside of New York, contact the
appropriate State Education Department.
D. Students Educated Outside the United States: A complete record (all years) of your high school/secondary
school education is required. Educational records in a language other than English must be accompanied by an
official word-for-word translation on business letterhead.
Step 3: Submit Test Scores
A. SAT or ACT Scores are required if you are applying to a four-year college and have graduated from a high school
in the United States within the past year. To request SAT or ACT scores, use the CUNY institutional code (2950).
You do not need to use both the CUNY institutional code and a specific CUNY college code.
B. TOEFL scores are required of all applicants who are on temporary visas and whose native language is not
English. Please use the CUNY institutional code (2950). You do not need to use both the CUNY institutional code
and a specific CUNY college code.
APPLICATION FOR FRESHMAN ADMISSION
Please be sure that this is the CORRECT APPLICATION for you.
W0008128202
Since graduating from high school or receiving a GED diploma,
have you attended a college, university, or postsecondary
institution?
YES ✔
NO
If your answer is YES, please DO NOT use this form. Contact the Office of Admission Services at (212) 997-CUNY (2869) for the Transfer application.
PLEASE PRINT IN BLUE OR BLACK INK. Refer to the instructions in the Freshman Admission application packet and be sure to answer the question above.
1
Applicant's Last Name
C U N Y
Applicant's First Name
Expected Date of Entrance
Fall
✔
4
Date of Birth
Spring
Year
3
Female
Suffix (Jr., Sr.)
(Any prior last name used)
Male
✔
0 2
2 6
1 9 9 5
Month
Day
Year
C U N Y
City
A V E N U E
State
N E W
5a
Apt. #
SA EN
T
M CO
PL PY
E
Applicant's Address
1 2
Y O R K
N Y
16/08
Length of time at the above address
5b
1
0
0 3 6 _
Length of time in N.Y.S.
Years / Months
Years / Months
Mailing Address (if different from above, or local address for international applicants)
2
C U N Y
City
N E W
Country
State
Y O R K
N Y
8
7
9 0 3 8
ST
0 5
U
Social Security Number
8 9 0
Apt. #
A V E N U E
D
1
Zip Code
5c
Length of time in N.Y.C.
Years / Months
6
2 0 1 3
MI
J O H N
5
2
8a
6 5 4
1 0 0
6 _
3
E-mail Address, if available
Day Telephone Number
7 1 8
Zip Code
JCUNY@CUNY.EDU
5 4 6 5
9
Evening Telephone Number
If you do not have a Social Security
Number, check below.
✔
Have you taken or do you plan to take the SAT I or Yes
ACT? Note: If you are applying to a CUNY
baccalaureate program and are in your last year of No
high school in the United States, or have graduated
from high school within the past year, you must
submit SAT I or ACT scores.
✔
CUNY COLLEGE CHOICES
10
10b
10a
Intended Major
I am considering preparing to become a
teacher in:
Early Childhood or Elementary School
Middle School or High School
Choices of Colleges and Curriculum: Before entering your college choices, please refer to the instructions. Indicate your choices in the boxes printed
below, in order of preference. You may list up to six choices. You must enter both the code and the college name.
1st Choice
0 2 0 2
Code
2nd Choice
Baruch College
0 3 3 7
Code
College Name
3rd Choice
0 5 0 5
Code
1 6 9 8
College Name
4th Choice
Brooklyn College
1 0 8 0
Code
College Name
5th Choice
Code
Hunter College
Kingsborough Community College
College Name
6th Choice
John Jay College of Criminal Justice
4 2 8 0
Code
College Name
-1-
Borough of Manhattan Community College
College Name
*** Student Copy ***
HIGH SCHOOL/SECONDARY SCHOOL INFORMATION
11
11a
Name of High School or GED Center
FOR UAPC USE ONLY
MURRY BERGTRAUM H S
H.S. Address:
411 PEARL ST
City
NEW YORK
While a high school student, did you take any college courses?
NY
State
12
✔ No
Yes
Date of actual or anticipated H.S. graduation or
receipt of GED
Number of Credits
Completed
0 6
2 0 1 3
Month
Year
Dates of Attendance:
to
College Name
Month/Year
13
Have you ever received financial aid?
Yes
14
✔ No
If yes, at:
Month/Year
Have you ever served in any branch of the U.S.
Armed Forces?
Yes
✔ No
Are you the dependent of someone who served
in a branch of the U.S. Armed Forces?
Yes
✔ No
Questions 15-16: Citizenship status and alienage are used to determine if any other educational documents are needed to evaluate your application and to
begin the visa process for temporary visa applicants. They are also used to determine your eligibility for available financial aid programs.
15
16
Are you a U.S. citizen?
✔
Yes
No
Immigration Status:
If no, please state:
U.S. permanent resident
Alien Registration (I551) Card #
Country of Birth
SEEK/CD:
Please Specify Type of Visa
Other
Date Obtained MM/YY
Date Obtained MM/YY
Expiration Date MM/YY
Explain
Complete questions 17-20 only if you wish to be considered for SEEK or College Discovery.
If you are placed into SEEK/CD, you will be required to provide proof of income eligibility to the financial aid office at the college.
If you are not applying to SEEK/CD, skip to Question 21.
For information regarding SEEK and College Discovery, consult
the CUNY Admission Guide.
18
Family Income - How much money did your family receive this year
from each source listed below? [Refer to your latest Federal Income
Tax Return (Form 1040) and other supporting documentation.]
A. Will you be 24 years of age before December
31 of your initial year at CUNY?
Yes
✔ No
Your own gross pay
$
B. Are you a veteran of the U.S. Armed Forces?
Yes
✔ No
Gross pay of wife/husband
$
C. As of today, are you married?
Yes
✔ No
D. Are you an orphan or a ward of the court, or
were you a ward of the court until age 18?
Gross pay of father/stepfather
$
7 5
Yes
✔ No
Gross pay of mother/stepmother
$
4 5
Income of other people included in Question 19B
$
D
17
SA EN
T
M CO
PL PY
E
Country of Citizenship
Temporary
Visa
ST
U
E. Do you have legal dependents (other than a
spouse) who receive more than half their
support from you?
F. Do you have children who receive more than
half their support from you?
Yes
Yes
✔ No
✔ No
Dividends, interest, rents, or other income from
investments
$
Social Security, unemployment insurance,
veteran's pension, other pensions
$
Welfare (public assistance, aid to dependent
children, etc.)
$
Other income
$
Total
$
If you answered "Yes" to any of the above questions, answer Questions
18-20 with information only for you, your spouse, and other family
members who live with you.
If you answered "No" to every question above, answer Questions 18-20
with information for you, your parents , and other family members who live
with you.
2
,
5 0 0
0
,
,
,
0 0 0
0 0 0
0
,
0
,
0
,
0
,
0
,
1 2 2
,
5 0 0
If other income, explain
19
20
A. How many people live in your household (including
yourself)?
B. Of the number reported above, how many are your:
1 Brother/Sister
2 Parents
0 4
How many people who live in your household are
working?
Please indicate their relationship to you.
✔
Children
Spouse
✔ Mother,
Stepmother
Wife or
Husband
Other
*** Student Copy ***
Father,
Stepfather
2
Yourself
Other
FOR UAPC USE ONLY
-2BATES
TRAN
ESL
CS
S
R
V
Response to Questions 21 through 23 is voluntary, and the information will be kept confidential. Refusal to provide this information will not affect your
application.
21
22
✔ No
Are you Hispanic / Latino?
Yes
Indicate your race by selecting
one or more options.
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
White
✔ Black or African American
What choice best identifies your ancestry or ethnic origin?
Bangladesh (012)
Cuba (038)
Greece (060)
Ireland (074)
Nigeria (113)
Russia (158)
Barbados (013)
Dominican Republic (045)
Guyana (065)
Israel (075)
Panama (117)
The Philippines (121)
China: Mainland (032)
Ecuador (046)
Haiti (066)
Italy (076)
Peru (120)
Trinidad (153)
China: Taiwan (148)
England, Scotland, or Wales (160)
Hong Kong (170)
Jamaica (077)
Poland (122)
Ukraine (223)
Colombia (033)
Germany (056)
India (070)
Korea (083)
Puerto Rico (185)
Vietnam (178)
23
SA EN
T
M CO
PL PY
E
Other - specify
Where were you and each of your parents born?
Check one in each column.
Born in the United States, excluding
Puerto Rico or U.S. Territories
You
Mother
Father
✔
✔
✔
Born in Puerto Rico or U.S. Territories
Born outside of the United States
24
Do you speak a language other than English at home?
Yes
No
24b
Your native language
ST
Father's full name
Father living?
Citizen of U.S.?
27
Yes
No
Yes
No
First Name
Father's occupation
Father's residence
State
30
Country
Mother's full name
Last Name
29
MI
26a
City
28
Equally comfortable
with both
Other languages spoken
Last Name
26
Language other than
English
U
ENGLISH
25
English
D
24a
If yes, with which language do you feel more comfortable?
Mother living?
Yes
No
Citizen of U.S.?
Yes
No
First Name
MI
29a
Mother's occupation
Mother's residence
City
State
Country
-3-
*** Student Copy ***
EDUCATIONAL INSTITUTIONS ATTENDED
31
A. List the secondary schools that you have attended, beginning with the most recent. Applicants do not have the discretion of omitting any part
of their educational history.
Name of Institution
Country
Your Age
While
Attending
Dates of
Attendance: From
N/A
SA EN
T
M CO
PL PY
E
MURRY BERGTRAUM H S
B. What diploma or certificate did you receive when you completed the secondary
school?
REGENTS DIPLOMA
Date
Awarded
Dates of
Attendance: To
06/2013
0 6
Month
2 0 1 3
Day
Year
ALL APPLICANTS MUST SIGN HERE
32
I hereby certify that all the information in this application is accurate and complete. I realize that failure to file the appropriate application may affect
my admission status. I understand that all the information contained in this application will be treated confidentially and will be used for institutional
purposes only.
Applicant's Signature:
Date:
ST
U
D
To ensure that your application is processed in a timely manner:
· Use paper clips, not staples, to attach documents to your application form.
· Print clearly on all application forms.
If you have been educated outside of the
· Where possible, submit all documents at the same time. CUNY cannot begin
United States:
processing your application until we have received every component, including
You have submitted photocopies of your
fees and transcripts.
secondary school documents/transcripts, mark
· Submit only one application.
sheets, and/or diploma.
· Please be sure to mail your completed application to UAPC at the P.O. Box number
specified below.
You have submitted translations of all foreign
Is your application complete?
All items are filled out completely and accurately.
language documents.
You have submitted a copy of your TOEFL exam,
if applicable.
You have enclosed the non-refundable money order or check.
You have included all names under which your transcripts may be filed.
You have requested that all official high school transcripts be sent to UAPC.
If you are applying to a baccalaureate program, you have requested that
SAT I or ACT scores be sent to UAPC. To request SAT I scores, you may
use either a single CUNY college choice code or the University's code
(2950), but use only one code.
You have made copies of your application and fee payment for your
records.
If you are a GED diploma holder, you have sent a photocopy of your diploma
and have requested that your GED scores and all high school transcripts be
sent to UAPC.
You can mail your transcript and money
order or check payable to UAPC to:
University Application Processing Center
P.O. Box 350136
Brooklyn, NY 11235-0001
FOR UAPC USE ONLY
V
M
TOEFL
NOTE: The City University of New York does not discriminate on the basis of age, sex, race, creed, color, national origin, physical or mental disability,
sexual orientation, marital status, alienage or citizenship status, or veteran's status.
-4-
*** Student Copy ***
High School Transcript Request Form
September 6, 2012
Instructions: Print this form and submit to your school counselor or guidance office so
that your transcript may be forwarded to CUNY/UAPC.
Student Information
John Cuny
12 Cuny Avenue
New York, NY 10036
M
To Whom It May Concern:
PL
High School Information
Murry Bergtraum H S
411 Pearl St
New York, NY 10038
E
Date of Birth: 02/26/1995
Graduation Date: 2013
I am applying to The City University of New York. Please send my high school
transcript, including SAT or ACT scores (if applicable) to the following address:
General Freshman Admission
CUNY/UAPC
P.O. Box 350136
Brooklyn, New York 11235-0001
SA
Freshman
*HTRN*
Please do not include a copy of the application with this document.
Yours truly,
John Cuny
W0008128202
(F)
Application Fee Return Receipt
September 6, 2012
Instructions: Print and mail this return receipt along with your non-refundable $65.00
check, money order, or CUNY Fee Waiver payable to CUNY/UAPC in a sealed envelope
to the following address:
E
General Freshman Admission
CUNY/UAPC
P.O. Box 350136
Brooklyn, New York 11235-0001
PL
Please do not include a copy of your application with this document.
Check the method of payment included with this receipt.
_____________
† Money order in the amount of
_____________
† Official CUNY Fee Waiver #
_____________
M
† Personal check in the amount of
SA
Freshman
*FEES*
Student Information
John Cuny
12 Cuny Avenue
New York, NY 10036
Date of Birth: 02/26/1995
Graduation Date: 2013
W0008128202
(F)
September 6, 2012
Instructions: Print and mail this receipt along with any supporting documents required to
complete your application. When possible, send all documents together in a single
envelope. Please remember to affix proper postage. Mail your materials in a sealed
envelope to the following address:
General Freshman Admission
CUNY/UAPC
P.O. Box 350136
Brooklyn, New York 11235-0001
E
Please do not include a copy of your application with this document.
PL
Check all the items included with this receipt.
Students Educated Within the United States
M
† GED (Test Scores & Diploma)
† SAT or ACT Score Report
† Other ___________________________
SA
Freshman
Document Return Receipt
Students Educated Outside the United States
† Secondary School Transcript(s)
† TOEFL Score Report
† Translation(s) of Academic Record(s)
† Other ___________________________
Student Information
John Cuny
12 Cuny Avenue
New York, NY 10036
Date of Birth: 02/26/1995
Graduation Date: 2013
Application Control Number: W0008128202
(F)