Carteret Community College C-STEP Interest Form Applicants should complete & return this form to one of the C-STEP advisors listed at the bottom of this sheet. A screening interview will be set up for you with one of the advisors if this form is fully completed and is accompanied by transcripts. CCC C-STEP Advisor: Melinda Rouse rousem@carteret.edu (252) 222-6175 133 McGee Bldg. Student’s Name/Birthdate: __________________________________________________________________________ Name Birthdate Mailing Address: __________________________________________________________________________________ Street City State Zip Phone Number/ E-Mail: ____________________________________________________________________________ Phone Number E-Mail Cumulative HS GPA/Graduation Date: _______________________________________________________________ GPA Month and Year of Graduation SAT, ACT, or CCC Placement Scores: ________________________________________________________________ (If available) Verbal/Critical Written Math Date Taken Anticipated major at UNC Chapel Hill? _______________________________________________________________ Which category best reflects your family’s gross annual income? $0–$30,000 $30,000–$60,000 $60,000–$80,000 Above $80,000 Family size: ____________ Number of immediate family members enrolled in college: _______________ Has anyone in your family ever attended UNC Chapel Hill? If so, please indicate____________________________ Copy of High School transcript (unofficial transcript is acceptable) Copy of Community College transcript (if applicable; unofficial transcript available through WebAdvisor) Parental Education (check each box that applies) Parent High School Diploma or GED Associate’s Degree Bachelor’s Degree Master’s Degree Mother Father Step-Mother Step-Father Consider carefully the following questions regarding the Carolina Student Transfer Excellence Program: I am interested in completing my A.S. or A. A. in two years. I am interested in attending University of North Carolina at Chapel Hill. I would like to dedicate a significant time to my academic studies in order to keep my GPA at 3.4 or above. (GPA must be a minimum of 3.0 at the time of graduation from CCC.) I would like to take a course load of at least 15 hours each semester. I am willing to take three levels of a foreign language while at the community college. I am willing to take Precalculus Algebra (MAT 171) and Precalculus Trig (MAT 172). I would like to participate in academic, social, leadership, and cultural activities once or twice a month. ___________________________________________________________* Student’s Signature ___________________________________________________________* Parent/Guardian’s Signature _________________________* Date _________________________* Date *Submission of this C-STEP Interest Form grants automatic approval for CCS, CCC, and UNC-CH staff to review this student’s transcript(s), reference(s), and related information/records. C-STEP APPLICATION & SUPPORTING DOCUMENTS Deadlines: Apr. 1st for high school seniors, Oct. 1st for community college students A. Essay: The ideal C-STEP candidate is someone with demonstrated academic potential, history of leadership, extracurricular involvement, and financial need. The selection process is a holistic one that may also consider factors such as the ability to overcome obstacles, first-generation college status, employment history, and family responsibilities. On a separate typed page, please explain in 500 words (or fewer) why you believe you would be a good candidate for C-STEP. The student’s essay is attached. ____ Yes B. High School Transcript: An official (sealed) copy of the student’s high school transcript is attached. ____ Yes An official (sealed) copy of the student’s college transcript is attached. ____ Yes C. Community College Transcript (if applicable): D. Student Aid Report (SAR) from FAFSA: E. Reference Letter #1 (Faculty): A copy of this report that includes the EFC is attached. ____Yes An official (sealed) copy from Reference #1 is attached. ____ Yes Reference #1 (Faculty): __________________________________________________________________ Name Work Phone/E-Mail F. Reference Letter #2 (Faculty or Staff): Department or Class ____ Yes An official (sealed) copy from Reference #2 is attached. Reference #2 (Faculty/Staff): ______________________________________________________________ Name G. Online Application & Honor Code: Work Phone/E-Mail Department or Class Official application form & honor code have been submitted on-line. All of the supporting documentation for the C-STEP application must be sent* to: Rebecca Egbert, Sr. Asst. Director and C-STEP Program Director Office of Undergraduate Admissions The University of North Carolina at Chapel Hill Jackson Hall, Campus Box 2200 Chapel Hill, NC 27599-2200 regbert@admissions.unc.edu *We recommend placing all application materials in one large envelope and sending it certified mail. _______Yes