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college application
This form is developed for, and is to be used by, the members of the Universal College Application. All members evaluate this form equally with all other forms
accepted by the institution. Please type or print neatly.
Possible Major
Regular Decision
Restrictive Early Action
Psychology
Early Decision
Early Action
payment information
Are you planning to apply for a counselor-approved fee waiver?
Yes
No
If you are applying for financial aid, when did/will you file the appropriate form(s) (FAFSA, CSS Profile, etc.)?
Yes
No
Male
Female
Spring of 2019
personal information
Please enter your name as it appears on your passport or other official documents.
Legal Name
Guillen
Last (Family)
Preferred Name
Dulce
Maria
First
Middle
(mm/dd/yyyy)
(###-##-####)
Dul_guillen@hotmail.com
Marital Status
Single
(single, married, etc.)
permanent address
Lauterbur Lane
607
Street Address
Apt. #
Champaign
Illinois
City/Town
Phone (
217
61822
State/Province
Country
390-8781
Alternate Phone (
Zip/Postal Code
)
Begin with Area or Country Code
Please give your current address for all admission correspondence, if different from above.
Lauterbur Lane
607
Street Address
Champaign
City/Town
Apt. #
Illinois
U.S.A
61822
State/Province
Country
Zip/Postal Code
217
390-8781
to
(mm/dd/yyyy)
(mm/dd/yyyy)
citizenship
Place of Birth
Chicago
Illinois
City/Town
US Citizen
U.S.A
State/Province
Country
Other Citizenship
Visa
If you live in the United States, but are not a U.S. citizen, how many years have you lived in the country?
If not English, language spoken in your home
ApplicationsOnline 2014 Universal College Application
Spanish
ethnicity
Race/Ethnicity information is optional. Information you provide will not be used in a discriminatory manner.
Are you Hispanic or Latino?
Yes
No
Leon, Guanajuato
How would you describe your racial background? (select one or more of the following categories):
Asian (country of familys origin
Black or African American
American Indian or Alaska Native (enrolled
Tribal affiliation
)
)
family information
parent/guardian #1
Parent
Guardian
Mother
Title
Male
Guillen
Araceli
Last (Family)
First
Female
Living?
N/A
Middle
Yes
Suffix
No (Date Deceased
)
(mm/yyyy)
City/Town
State/Province
708
Phone (
Apt. #
Country
) 768-4434
Zip/Postal Code
Faraceli47@yahoo.com
N/A
Profession
Position
N/A
N/A
Employer
College Attended (if any)
Degree Earned
Year
Year
parent/guardian #2
Parent
Guardian
Father
Title
Male
Guillen
Last (Family)
Female
Angel
First
Living?
Middle
Yes
Suffix
No (Date Deceased
)
(mm/yyyy)
City/Town
Phone (
708
Apt. #
State/Province
Country
768-4434
Zip/Postal Code
angel-guillen@sbcglobal.net
Profession
Employer
Supervisor
Position
Supervisor
Gill Athletics
Degree Earned
Year
Year
Both
(mm/yyyy)
Parent/Guardian#1
Parent/Guardian#2
List names, genders, and ages of your siblings, college (if any), degree(s), and dates of attendance.
Name
Gender
Age
Institution
Other (Explain)
Degree(s)
Dates
Male 28
academic information
Franklin Middle School
School
Type of school:
Public
Private
Correspondence
CEEB Code
Charter
Parochial
Home-School
Other/Education Provider
School Address
Champaign
IL
City/Town
Start Date
USA
State/Province
61820
Country
8/2012
Zip/Postal Code
5/2015
Date of Graduation
(mm/yyyy)
(mm/yyyy)
Kristin Monahan
Counselors Name
Phone (
217
) 351-3819
Counselors Email
monahakr@champaignschools.org
Fax (
)
Begin with Area or Country Code
Yes
No
Yes
No
Yes
No
If your education has been interrupted, please detail your activities since last enrolled. Please attach your response to the end of the application.
Spanish
Semester #2/Trimester #2
Spanish
Honors Math
Honors Math
Social Studies
Social Studies
Writing
Writing
AVID
AVID
Honors Reading
Honors Reading
Science
Science
List all other high schools, colleges/universities (including summers), and academic programs you attended, beginning with ninth grade.
You must submit transcripts from each school.
CEEB Code
Dates Attended
Location
CEEB Code
Dates Attended
Location
colleges/universities
School Name
Test Date
Subject
Score
Test Date
Subject
Score
Test Date
Subject
Score
Test Date
Subject
Score
Test Date
Subject
Score
Test Date
Subject
Score
SAT Reasoning
Test Date
Verbal/
Critical Reading
Math
Writing
Test Date
Verbal/
Critical Reading
Test Date
Verbal/
Critical Reading
Math
Writing
Test Date
Subject
Test Date
Math
Writing
Score
Test Date
Subject
Score
Subject
Score
Test Date
Subject
Score
Test Date
Subject
Score
Test Date
Subject
Score
Test Date
English
Math
Reading
Science
Composite
Combination
English/Writing
Test Date
English
Math
Reading
Science
Composite
Combination
English/Writing
Test Date
English
Math
Reading
Science
Composite
Combination
English/Writing
Test of English as a
Foreign Language Test Date
(TOEFL or other exam)
Subject
Score
Test Date
Subject
Score
SAT Subject
ACT
academic distinctions
Please list any academic or educational awards and honors you received in high school (e.g. National Merit, National Honor Society).
Please attach your response to the end of the application.
(including summer)
Please list any significant extracurricular or community activities and hobbies in which you have participated. Include specific accomplishments such as musical
accolades, athletic distinctions, etc. (Please note: PG means Post-Graduate)
Activity
Grade Level
Specific Accomplishments
Hours/
Week
Weeks/
Year
Cheerleading
10
11
12
PG
NJHS
10
11
12
PG
+3
Culture Club
10
11
12
PG
Tutoring
10
11
12
PG
Church Volunteering
10
11
12
PG
AVID
10
11
12
PG
10
11
12
PG
Avid Ambassador
15-20
Yes
No
Unsure
Yes
No
Unsure
Yes
No
Unsure
| year
Yes
No
Unsure
1.5
Yes
No
Unsure
Yes
No
Unsure
Yes
No
Unsure
round
sundays
employment information
List any work experience (including summer jobs) during the past three years.
Employer
Job Description
Taco Stand
Cashier/Cook
Babysitting
Yard Work
Dates of Employment
Every summer
October, 2014
Mowed Lawns
Summer of 2012
2-4
activity description
Tell us more about one of your extracurricular, volunteer, or employment activities (100-150 words). If you need more space, please attach your response to the
end of the application.
Tutoring was such an amazing experience! I wouldn't change it for the world. The thought of growing
and changing a person for the better, of educating them, of being someone special in their life! I adore
everything about it. I started tutoring when I was in 5th grade; my math teacher noticed my eagerness,
along with my intelligence, to learn and teach. They assigned a 3rd grade girl to me, so I could teach
her how to read. At first, I wasn't interested. I could barely keep up with school work myself. But then I
thought, why not? Well, long story short, I ended up loving it! And since then, I couldn't stop. I love being
there for people through rough times. I know they have the capability to learn, some just learn more
quicker than others. Since then, I've tutored kids with Spanish, Math and Reading.
personal statement
Please write an essay (650 words or fewer) that demonstrates your ability to develop and communicate your thoughts. Some ideas include: a person you admire;
a life-changing experience; or your viewpoint on a particular current event. Please attach your response to the end of your application.
multimedia information
Optional: You may provide your selected college(s) with a link to any online content you feel:
1. Tells the college more about yourself 2. Demonstrates a particular talent you possess 3. Highlights an activity in which you participated
Some ideas include linking to an online video you created, a portfolio (pictures or photographs), a musical composition, or a newspaper article.
http://
Please briefly describe the contents of the link you provided.
additional information
If you have additional information that was not specifically requested on the application or did not fit in the space provided, feel free to include it here.
If you need more space, please attach your response to the end of the application.
discipline information
Have you ever been placed on probation, suspended, removed, dismissed or expelled from any school
or academic program since 9th grade?
Yes
No
Other than traffic offenses, have you ever been convicted of any misdemeanor, felony, or other crime?
Yes
No
If you answered yes to either question, please provide an explanation and the approximate dates of each incident.
Please attach your response to the end of the application.
authorization
Your signature below
1. authorizes all schools you attended to provide all requested records and allow review of your application for the admission process chosen on this application.
2. confirms all information in this application (including any supplemental information) is factually true and honestly presented and that you are the person
submitting this application.
Signature of applicant
Date