Name:
Current Address Street: City: State: Zip:
Phone:
E-mail address (Penn preferred):
Campus Address (if known) College House: Building name: Room number:
Cell Phone:
Penn ID number (This is an 8-digit number in bold on your PennCard. You can also find it in your PennKey set up letter, or on CampusExpress if you set up your PennKey. Otherwise leave blank):
T-shirt size: Choose one Youth Large S M L XL XXL
School and Academic Major:
Hobbies/Special Interests:
Optional Demographic Information:
Race/Ethnicity:
Gender:
Religion:
Are you taking any medication? If yes, please specify:
Are there any medical conditions of which we should be aware? If yes, please specify:
Please respond briefly to the following questions.
1. Why do you want to participate in PENNacle?
2. Leadership and activities in high school:
3. What person, fictional or real, would you say best fits the ideal of a leader and why?
4. Describe a situation in which you failed to be a leader. What were the obstacles you needed to overcome? In retrospect, would you do anything different?
5. If you were stranded on a deserted island with three other people, 1000 bricks and nothing else, what would you do?
Choose one: I am applying to this pre-orientation program only. I am applying to more than one pre-orientation program. My preferences in order are:
1. Choose one PENNacle PennArts PennCORP PennGreen PennQuest 2. Choose one PENNacle PennArtsPennCORP PennGreen PennQuest 3. Choose one PENNacle PennArtsPennCORP PennGreen PennQuest 4. Choose one PENNacle PennArtsPennCORP PennGreen PennQuest 5. Choose one PENNacle PennArts PennCORP PennGreen PennQuest
I understand the PENNacle program is scheduled from Monday, August 31 - Thursday, September 3, 2009. The cost of the program is $275.00 which I agree to pay immediately upon receipt of the acceptance packet. **
** Note: For those students eligible for financial aid through the University of Pennsylvania, limited financial assistance is available. Please indicate if you wish to be considered.
Yes, I am eligible for financial aid through Penn and wish to be considered for financial assistance to support my participation in the PENNacle program. (Any type of financial aid or work-study through the University qualifies).
Please submit your application by June 30, 2009. If you have questions, feel free to write Rodney Robinson in the Office of Student Life .
