NAME:__________________________________________________ GRADE/RANK:_____________

OFFICE ADDRESS:________________________________________ TELEPHONE #____________

_________________________________________________________

HOME ADDRESS:_________________________________________ TELEPHONE #_____________

_________________________________________________________

COLLEGE(s) OR UNIVERSITY(ies) YOU HAVE ATTENDED:

NAME LOCATION DATES ATTENDED

________________________ _____________________________________ __________________

________________________ _____________________________________ __________________

________________________ _____________________________________ __________________

COLLEGE ENTRANCE EXAM NAME AND SCORE (if available):

DEGREE SOUGHT:_________________ MAJOR FIELD OF STUDY:__________________________________

NUMBER OF HOUR COMPLETED: GPA:

ATTACH THE FOLLOWING:

1. AUTOBIOGRAPHY: 200-300 WORDS INCLUDING YOUR PERSONAL HISTORY AND FUTURE

GOALS (word processing preferable).

2. COLLEGE TRANSCRIPT (for all colleges attended) (copies acceptable), or LETTER OF ACCEPTANCE

FROM COLLEGE/UNIVERSITY (if not previously enrolled).

3. LETTER OF RECOMMENDATION FROM YOUR SUPERVISOR WITH ENDORSEMENT FROM YOUR

COMPTROLLER or CFO.

MAIL TO: William G. Pazeretsky

13355 Galicia