ARC Honors Program Information Request Form

HONORS PROGRAM

Information Request Form

* below indicates required field

1. About You
* Last Name
* First Name
* Mailing Address
* City
* Zip Code
E-mail Address
* Daytime Phone (Area code and phone number)
* Evening Phone (Area code and phone number)
* Best Way to Contact You (Use drop-down menu at right)
* Date of Birth (MM/DD/YYYY) For example: 08/06/1987
2. About Your Education
*A. Educational Background** (Use drop-down menu at right)
*B. Educational Goals**	(Check all that apply)
Transfer to UC
Transfer to CSU
Transfer to Private/Out-of-State University
Undecided or Other
Your Preferred Transfer Institution	(List up to three)
Preferred Institution 1
Preferred Institution 2
Preferred Institution 3
*C. Previous Honors Coursework**	(Check all that apply)
Advanced Placement Courses
International Baccalaureate Program
High School Honors Courses
College Honors Courses
None
D. New Students Only
High School GPA Please fill in, and note whether out of 4.0 or 5.0 total points. Example: "3.5 out of 4.0"
E. Continuing/Re-entry Students Only
Cumulative College/University GPA
F. Asessment
Have you completed the ARC English and Reading assessment process? (Use drop-down menu at right)
If Yes, please fill in your score here.
3. Follow-Up
A. How Did You Hear About Us?	(Check all that apply)
ARC Information
Letter from ARC Honors Program
ARC Honors Brochure
Instructor Recommendation
Counselor Recommendation
Student in Honors Program
Other (please specify)
B. Comments/Questions

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When done, click on the Submit button below.