2013 Honors Program and Centralis Scholarship Application
(for those planning to enter CMU Fall 2013)
The minimum eligibility requirements to compete for the Centralis and University Honors Scholarships are a 3.7 high
school GPA and a 27 ACT. In addition, applicants must complete this application and bring it with them to one of the
two on-campus scholarship competition days, (October 27, 2012 or November 10, 2012). At the competition applicants
will write an impromptu essay that will count as part of their scholarship application. Registration for the Scholarship
Competition Day must be completed by October 19. To reserve your place at the competition, register online by Oct. 19
at go.cmich.edu/visit or by phone at (989)-774-3076 or toll-free (888) 292-5366.
IMPORTANT: Students attending the Centralis and University Honors Scholarship Competition Days on campus
MUST bring this completed scholarship application WITH THEM to the Centralis and University Honors Scholarship
Competition Day. Failure to present this completed application at the competition day would make them
ineligible to compete for the Centralis Scholarship and the opportunity to compete for early priority admission to
the CMU Honors Program and the corresponding University Honors Scholarship.
Note: If you are writing the competition essay at a proctored test site, your essay and this application must be mailed to CMU, in one
envelope, with a postmark no later than November 10, 2012, to: CMU Honors Program Office, 104 Powers Hall, Mount Pleasant, MI 48859.
Please provide answers to the following questions.
When will you compete for a Centralis/Honors Scholarship? (circle one)
What is the status of your admission to CMU? (circle one)
First Name
October 27
November 10
Already admitted
Middle Initial
Proctored on-site by Nov 10
Awaiting a decision Have not yet applied
Last Name
CMU ID Number (if known)
Mother’s Name
Father’s Name
Permanent Address (Street, City, State, Zip Code)
Home Phone
Cell Phone
Date of Birth (Month, Day, Year)
Email Address
Gender (circle one)
Male Female
Intended Major/Area of Study (if unknown, please describe academic interests)
Date of Entry to CMU (ex: Fall 2013)
High School Attending
High School Phone Number
High School Graduation Date
(include city and state)
Cumulative High
Composite
Class Rank
School GPA
ACT Score
(if known)
In the space below please provide contact information for two individuals who can and will speak to your academic promise:
Name
How do you know this person
Phone
1
(
)
2
(
)
Email
New college students who reside with parents that have not completed a four year college degree (Bachelors Degree) are
sometimes referred to as a “first generation college student”. Are you a first generation college student?
Please circle one:
Yes
No
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I. Profile Information You may attach extra pages if you need more space to list or describe activities in any category.
Foreign Study
Have you studied in a foreign country?
Circle one:
Yes
If so where?
For how long?
If so where?
For how long?
No
Foreign Travel
Have you traveled to or lived in a foreign
country?
Circle one:
Traveled to
Lived in
Foreign Language Studied or Spoken
Language 1:
Number of Years:
Language 2:
Number of Years:
Special Coursework—Please list any coursework taken in the following areas during high school. Honors course
work, advanced course work, Advanced Placement (AP) course work, and/or dual-enrollment at a community
college.
Course Title
Example: BIO 101
Type of Course
Example: Dual-Enrollment at LCC
Semester
Spring 2005
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Grade
In progress
Memberships and Extracurricular Activities:
Include involvement in clubs, organizations, conferences, and other significant activities at your
high school or in your community in which you had a LEADERSHIP ROLE (i.e. President, Secretary, Captain, Director, Chairperson, Coach, etc.)
Total Number of
Fr
Years Involved
Organization or
Hours Invested
(please circle)
Group Name
During High School
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Example: Spanish Club
40
Position / Duties
Treasurer
Responsibilities
Handled financial matters
Of the above extracurricular activities briefly describe which was most meaningful to you and why?
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Community and Volunteer Service—Include all the community service projects you have participated in
throughout your high school years.
Years of Service
Organization or Group Name
(please circle)
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Total Hours Contributed
Description of Activity
Per Project / Site
Example: Elm Street Soup Kitchen
30
Volunteered on a weekly basis at the local soup kitchen
Enter your COMBINED TOTAL HOURS of service
completed….
Of the above service activities briefly describe which was the most meaningful to you and why?
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Awards and Honors. Include awards, honors, and scholarships you received from your high school and any national,
church, community, or business organizations. Include academic, music, and athletic awards. Do not include honor
roll, NHS, or CMU Board of Trustees Scholarship.
Years Involved
Organization or Group Name
Award Title
(please circle)
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Fr
So
Jr
Sr
Example: Band
The John Philip Sousa Award
II. Creative Piece and Personal Statement
The University Honors Program is designed to provide high academic ability students with unique educational
opportunities and challenges consistent with a specific mission and set of values. This means that Honors education
at CMU is not necessarily well suited for all high academic ability students equally. With this in mind, please first take
some time to carefully reflect on the formal CMU Honors Program mission and values statements below:
Mission
Providing high academic ability students with unique educational opportunities and experiences, the CMU Honors
Program challenges students to aim higher and to achieve more academically, personally, and professionally for the
greater good of our disciplines, our society, and our world.
Core Values
The primary values that guide the implementation of the Honors Program mission include:
 Critical thought, scholarly inquiry, and creative expression
 Respect and appreciation for diverse peoples and ideas in a global society
 High standards for integrity and personal aspirations
 Active citizenship and service for the greater good
(Creative Piece and Personal Statement guidelines continued
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on next page…)
Part 1 (Creative piece): On an 8.5 x 11 sheet of paper, (one side only) make a creative presentation that describes
who you are and what you bring to the Honors community. Any medium or format is acceptable as long as it fits
on the page. There are no set guidelines for this part of the application. We want you to use this as an
opportunity to express yourself in a creative fashion and we don’t want to limit that creativity.
Part 2 (Written personal statement): Given your assessment of how you fit with our Honors Program mission and
core values, you are challenged to write a thoughtful personal statement that highlights why you believe you are a
good fit with University Honors. Beyond the facts already listed in your application, what would you share with
the Honors Program Review Committee to help them understand why you should be selected to join our CMU
Honors community? Please limit your response to 500 words or less.
Your goal in completing the 1) creative piece and the 2) written personal statement is to distinguish yourself from the
other Honors Program applicants. This is your opportunity to introduce yourself to the review committee, as you
wish, and to make your case for why you should be selected to join our University Honors community!
Both the written personal statement and the creative piece must be securely attached to your application to receive
full consideration in the review process.
III. Competition Essay
Your Competition Essay will be accessed and reviewed for quality of writing as well as evidence of critical thought. You
will receive the prompt for the essay at the Competition and have one hour to respond on-site to the prompt.
Additional Information:
After you have completed this application, we recommend that you review it with a school administrator or counselor.
We also suggest that you make photocopies of the entire application for your records as we will not return these items
to you or be able to provide copies for you at a later date.
By signing this application you attest that all of the information is true, to the best of your knowledge, and you agree
to allow verification by Central Michigan University.
Signature of Applicant: _______________________________________ Date _______________________________
APPLICATION SUBMISSION INFORMATION:
IMPORTANT: Students attending the Centralis and University Scholarship Competition Days on campus MUST
bring this completed scholarship application WITH THEM to the Competition Day. Failure to present this
completed application at the competition day would make them ineligible to compete for the Centralis Scholarship
and the opportunity to compete for early priority admission to the CMU Honors Program and the corresponding
University Honors Scholarship.
Note: If you are writing the competition essay at a proctored test site, your essay and this application must be mailed to CMU, in
one envelope, with a postmark no later than November 10, 2012 to: CMU Honors Program Office, 104 Powers Hall, Mount
Pleasant, MI 48859.
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CMU an AA/EO institution strongly and actively strives to increase diversity with in the community. (See www.cmich.edu/aaeo)
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