General Information:

Name:

Parent / Guardian Name(s):

Address1

Address2

City

State

Zip Code

Telephone:

E-mail:

Birth Date:

Graduation Date:

Scholastic Information:

High School:

Cumulative High School GPA:

(un-weighted 4.0 scale)

ACT/SAT Score:

Cumulative College GPA:

(if applicable, un-weighted 4.0 scale)

Major:

Essays:

List Honors, Awards, and Scholarships:

List Extracurricular Activities, Leadership Positions Held, and Durattion of Positions:

List Work Experience (employer, time employed, and description of work performed:

If you wish to submit a resume you may do so by e-mailing it to bms"@"unosigep.org.

Should you have any questions please call Clete DeWispelare at (402) 367-8640 or via e-mail to bms"@"unosigep.org.

By checking this box you affirm that all information supplied is truthful and 100% accurate to the best of your knowledge.