John Dewey

Page 1

2010-11 First-year Application For Spring 2011 or Fall 2011 Enrollment

APPLIC ANT Dewey John Legal Name ___________________________________________________________________________________________________________________ Last/Family/Sur (Enter name exactly as it appears on official documents.)

First/Given

Middle (complete)

Jr., etc.

Preferred name, if not first name (choose only one) ______________________

Former last name(s), if any _______________________________________

10/20/1859 Birth Date ____________________________________________________ Female Male

US Social Security Number, if any ___________________________________

mm/dd/yyyy

Optional, unless applying for US Federal financial aid with the FAFSA form

Preferred Telephone Home Cell Home (_______) __________________________________ Cell (_______) __________________________________ Area/Country/City Code

Area/Country/City Code

E-mail Address ________________________________________________

IM Address ____________________________________________________

Permanent home address __________________________________________________________________________________________________________ Number & Street

Apartment #

____________________________________________________________________________________________________________________________ City/Town

County or Parish

State/Province

Country

If different from above, please give your current mailing address for all admission correspondence.

ZIP/Postal Code

(from ___________ to ___________) (mm/dd/yyyy)

(mm/dd/yyyy)

Current mailing address __________________________________________________________________________________________________________ Number & Street

Apartment #

____________________________________________________________________________________________________________________________ City/Town

County or Parish

State/Province

Country

ZIP/Postal Code

If your current mailing address is a boarding school, include name of school here: ____________________________________________________________ _____

FUTURE PLANS Your answers to these questions will vary for different colleges. If the online system did not ask you to answer some of the questions you see in this section, this college chose not to ask that question of its applicants.

Johns Hopkins University College ________________________________________________________

Deadline ______________________________________________________ mm/dd/yyyy

Entry Term: Fall (Jul-Dec)

Spring (Jan-Jun)

Do you intend to apply for need-based financial aid?

Yes No

Decision Plan___________________________________________________ Philosophy Academic Interests _____________________________________________

Do you intend to apply for merit-based scholarships?

Psychology ____________________________________________________________

Do you intend to enroll in a degree program your first year?

Yes No Yes No Yes No

Philosophy ____________________________________________________________

No Do you intend to live in college housing? ______________________________

Professor Career Interest _________________________________________________

M.D. What is the highest degree you intend to earn? _________________________

Do you intend to be a full-time student?

DEMOGRAPHICS Citizen Citizenship Status ______________________________________________

1. Are you Hispanic/Latino?

N/A Non-US Citizenship ______________________________________________

Yes, Hispanic or Latino (including Spain) No

_____________________________________________________________ _____________________________________________________________ 52 Years lived in the US? ____________________________________________ Vermont United States Burlington Birthplace ________________________________________________________ City/Town

State/Province

Country

_________________________________________________________________________

2. Regardless of your answer to the prior question, please indicate how you identify yourself. (Check all that apply.) American Indian or Alaska Native (including all Original Peoples of the Americas) Are you Enrolled? Yes No If yes, please enter Tribal Enrollment Number________________ _________________________________________________________________________

English First Language _________________________________________________ English Primary language spoken at home _____________________________________

Asian (including Indian subcontinent and Philippines)

Conversational French Are you proficient in any other languages? _______________________________ from my Childhood _________________________________________________________________

Black or African American (including Africa and Caribbean)

_________________________________________________________________________

_________________________________________________________________________

Optional The items with a gray background are optional. No information you provide will be used in a discriminatory manner. Twice Married, Married to Alice Chipman Marital Status ____________________________________________________ Christian- Protestant Religious Preference _______________________________________________ US Armed Services veteran? Yes No ©

2010 The Common Application, Inc.

Native Hawaiian or Other Pacific Islander (Original Peoples) _________________________________________________________________________

White (including Middle Eastern) _________________________________________________________________________

AP-1 / 2010-11


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