| Name: | ____________________________________________________ | |
| Permanent Address: | ____________________________________________________ | |
| (Street Address) | ||
| ____________________________________________________ | ||
| (City, State, Zip + 4) | ||
| Current Address: | ____________________________________________________ | |
| (Street Address) | ||
| ____________________________________________________ | ||
| (City, State, Zip + 4) | ||
| Permanent Phone: | ____________________________________________________ | |
| (Area code + number) | ||
| Current Phone: | ____________________________________________________ | |
| (Area code + number) | ||
| School/College/University Currently Attending: | ____________________________________________________ | |
| ____________________________________________________ | ||
| (City, State) | ||
| Career Counselor or Advisor Name: | ____________________________________________________ | |
| Career Counselor or Advisor Phone: | ____________________________________________________ | |
| (Area code + number) | ||
| GPA: | ____________________________________________________ | |
| Advertising Related Courses Taken: | ____________________________________________________ | |
| ____________________________________________________ | ||
| Favorite Course: | ____________________________________________________ | |
| Why? | ____________________________________________________ | |
| ____________________________________________________ | ||
| Advertising related extracurricular activities: | ____________________________________________________ | |
| ____________________________________________________ | ||