* denotes required

Name

        First Name: *

        Middle Name:

        Last Name: *

Gender

Male

Female

Telephone

        Home:

        Cell:

Email Address: *

Student ID Number:

Do you work?

Yes

No

If so, how many hours per week?

High School

        Name:

        City:

        State: Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Mississippi Missouri Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

        Year of Grad:

College Attended

        Name:

        City:

        State: Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Mississippi Missouri Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

        Dates Attended:

        Total Units:

        Number of Transfer Units:

        Cum GPA:

High School Grade Point Average

        Unweighted:

        Weighted:

        College Cum GPA:

SAT/ACT Scores

        Critical Reading:

        Math:

        Writing:

        SAT Total:

        ACT Total:

Long Beach City College Assessment Test Place Results
(must have results before application can be considered):

        Writing: Select one English 1 English 105 English 801

        Reading: Select one Read 82 Read 882 Reading requirement satisfied

Anticipated Transfer University:

Anticipated Transfer Date:

Anticipated major(s)
If unknown, state general area of interest: Enter your major or area of interest here

Anticipated Career(s):

Describe briefly your principal extracurricular activities, including school and community groups, hobbies, and strong interests: Enter the activities here

If you have participated in an honors program before, please complete the following:

        Name of Program and School:

        Dates of Participation:

Have you been certified as a "Distinguished Scholar" by Lakewood, Millikan QUEST, or Wilson High Schools?

Yes

No

        Name of School:

In order to complete the application process, please submit your transcripts to the Honors Program office (L203A) and obtain two recommendations. Your recommenders may submit their letters either in the online format from this web site, or they may turn in a printed form (pdf file) (requires Adobe Reader) to the Honors Program office.

Thank you for submitting this part of the application to the Honors Program. When your application is complete, the Honors Program will contact you regarding your admission to the program.