Student Multicultural Center
Academic STARS
(STudents Achieving and Reaching Success)
Program Application
(PLEASE PRINT LEGIBLY OR TYPE APPLICATION)
Personal Information:
Name: ________________________________________________________________________
FIRST
MI
LAST
Address: __________________________________________________ Apt.# _____________
City:_________________________________ State: ____________ Zip: ____________
Phone: (
)______________________
Cell Phone: (
Kent State Banner ID: _________________________
) ___________________
Gender: □ Male □ Female
(This is 10-digit number assigned to you by the Admissions Office beginning with 810)
Ethnic Background: _____________________________________________________________
Email Address: _________________________________________________________________
Date of Birth: ______/_______/_______
Selected Major: _____________________________
(This is what you plan to major in at Kent State)
Parental Information:
Name: _______________________________________________________________________
Phone: (
)_____________________
Cell Phone: (
)_________________
Email Address: _______________________________________ (REQUIRED)
Relation to student: _____________________________________________________________
Name: _______________________________________________________________________
Phone: (
)_____________________
Cell Phone: (
)_________________
Email Address: _______________________________________ (REQUIRED)
Relation to student: _____________________________________________________________
School Information:
High School: __________________________________ Current Grade Point Average:______
Address: _____________________________________________________________________
Phone Number: (
) _________________School website address: ______________________
ACT Composite Score ________
ACT English Score ________
SAT Composite Score ________
SAT Writing Score ________
Do you currently hold post-secondary credits? Yes or No
If yes, in what classes?________________________________
Clubs, organizations and/or extra-curricular activities involved in:
______________________________________________________________________________
______________________________________________________________________________
Honors/Awards received:
______________________________________________________________________________
_____________________________________________________________________________
Volunteer Work in the Community:
______________________________________________________________________________
Essay Prompt
(12pt font, double spaced, 1” margins)
Please prepare a TYPED 450 WORD response to the following question:
“The Academic STARS program works to inspire participants to become students of great character who
will make significant contributions to the campus, community and the world. If given the opportunity to
participate, how will you live up to this expectation?”
____________________________________________________
Applicant’s Signature
_____________________________________________________
Parent’s Signature
_________________
Date
_________________
Date