Name: Male Female Born: Month: Day: Year:
United States Citizen or National Lawful Permanent Resident Social Security Number:
Term first enrolled or planning to enroll in Loyola: Fall Spring Summer 20 Expected Computer Science Degree Program:
Permanent Address: Number and Street: City: State: Zip: Home Phone: ( ) -
Cell Phone: ( ) - E-mail address:
(If you need more room for section B, you may make an attachment.)
Please provide the information requested below for all undergraduate colleges and universities attended beginning with the most recent.
Dates of attendance are Month/Year-Month/Year. GPAs are cummulative grade point average after Fall 2012.
Please provide the information requested below for all graduate work attempted or completed, including professional schools, beginning with the most recent.
See next page for additional directions.
Signature: Date:
Type and attach a personal statement of approximately 250 words (one double-spaced page) to support your application. You may discuss such topics as your reasons for choosing your field of study, how you plan to use your education after graduation, leadership and service activities in which you have engaged, and/or how you have overcome hardships to pursue your goals. (Note that the personal statement in your admission application will also be available to the scholarship selection committee.)
Students not yet admitted to Loyola, must also submit all admission materials by February 1, 2013.
Please make a copy of your completed application for your records.
Loyola University Chicago is an equal opportunity educator and employer and admits students without regard to their race, color, sex or national or ethnic origin. Qualified persons are not subject to discrimination on the basis of handicap.
