The Honors Transfer Alliance Program Membership Application

Name ___________________________________     SS# _______________________________

Address ____________________________________________________________________

                                                                                                                                                City                                               State         Zip

Telephone __________________      E-mail address _________________________________

Date submitted ________________________          AVC grade point average ____________

                                                                                                  (Must be 3.25 or higher)

Have you taken 12 or more academic units at AVC?                       Yes                     No

(If yes, no need to attach transcript.)

Have you attended another college or university?                         Yes                     No

(If yes, please attach a copy of your transcript.)

Are you currently a high school student?                                           Yes                     No

(If yes, please attach your transcript and indicate your GPA and SAT score below)        

High School GPA __________________                     SAT Score ____________     

(must be 3.5 or higher)                                                                               (must be 1600 or higher)

• Attach an essay of two pages or more, typed and double-spaced, to this application to serve as a writing sample.  You may submit a recent essay from a class.  (It will not be returned).

• List any honors, awards, achievements, or community service that you have participated in including advanced placement courses.  (You may continue on the reverse.)

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

By signing this application, I have read and understand the following:

• I must maintain a 3.25 GPA (without earning under a “C” in any honors course).
• It is my responsibility to make annual appointments with the honors coordinator and honors counselor to discuss my academic progress.
• It is my sole responsibility to complete the requirements of any honors option contract with my professor and to turn in all contract paperwork to the honors coordinator.  Contracts are due by the fourth week of the semester. 

____________________________________________

(signature)

Submit your application, along with appropriate documents, to the honors coordinator:

Ms. Karen Lubick          (661) 722-6468             klubick@avc.edu           Office OF3 166

For more information regarding the honors program: http://www.avc.edu/honors/index.html

 NON-DISCRIMINATION POLICY

Antelope Valley College prohibits discrimination and harassment based on sex, gender, race, color, religion, national origin or ancestry, age, disability, marital status, sexual orientation, cancer-related medical condition, or genetic predisposition.  Upon request, we will consider reasonable accommodation to permit individuals with protected disabilities to (a) complete the employment or admission process, (b) perform essential job functions, (c) enjoy benefits and privileges of similarly-situated individuals without disabilities, and (d) participate in instruction, programs, services, activities, or events.