M F Single MarriedPlease type or print clearly

1. Name in Full ____________________________________________________________________ ______________________________Last First Middle Social Security Number

Are you known by any other name: Yes No If yes, please state __________________________________________________

2. Permanent Address ________________________________________________________________________________________________Number and Street City and State Zip

Telephone Number _________________________________________________ E-mail ______________________________________Area Code + number

Temporary Address ________________________________________________________________________________________________Number and Street City and State Zip

Temporary Phone Number ____________________________________________________ Until _____/_____/____

3. Place of Birth ________________________________________________________________ Date of Birth ______________________

4. Height _____________________________________________________________________ Weight ___________________________

5. Father’s Name in Full _____________________________________________________________________ Living Deceased

Address (if living) _________________________________________________________________________________________________

Father’s Occupation _______________________________________________________________________________________________

Mother’s Name in Full including Maiden Name_______________________________________________ Living Deceased

Address (if living) _________________________________________________________________________________________________

Mother’s Occupation ______________________________________________________________________________________________

Or, if applicable

Guardian’s Name ____________________________________________________________ Occupation _________________________

Guardian’s Address ________________________________________________________________________________________________

6. Which languages are spoken in your home? ___________________________________________________________________________

Which languages do you speak fluently? ___________________________________ Read ___________________________________

7. Have you seen a doctor in the last five years for any reason other than a normal checkup? Yes No

If yes, please explain ______________________________________________________________________________________________

8. Are you presently undergoing any medical treatment? Yes No

If yes, please explain ______________________________________________________________________________________________

9. Have you taken College Entrance Board examinations? Yes No

If yes, please include your Date(s) ______________________ ______________________ __________________________

and Test Score(s) _______________________ ______________________ __________________________

Have you taken ACT examination? Yes No

If yes, please include your Date(s) _________________________ ______________________ __________________________

and Test Score(s) _______________________ ______________________ __________________________

Note: Further details regarding entrance requirements to Duquesne University may be obtained from the Director of Admissions,Duquesne University, Pittsburgh, Pennsylvania 15282

1801 Boulevard of the Allies • Pittsburgh, PA 15219 • 412.396.5185 • fax 412.396.5583www.tamburitzans.duq.edu • tamburitzans@duq.edu

SCHOLARSHIP APPLICATION

10. High School Attended ____________________________________________________________________________________________

_______________________________________________________________________________________________________________Number and Street City and State Zip

Telephone Number ____________________________________ Area Code + number

Name of Principal _____________________________________ Name of Guidance Counselor _____________________________

Date of Graduation ____________________________________ Scholastic Average _______________________________________

Approximate (A, B, C or QPA)

11. I desire to enter Duquesne University in the Fall semester of (enter year) __________________________________________________

12. Have you applied for admission to Duquesne University? Yes No

Have you been accepted? Yes No

(It is recommended that this be done at the same time this application form is completed.)

All applicants must fill out the APPLICATION FOR FEDERAL STUDENT AID and all Pennsylvania applicants must also fill out the

APPLICATION FOR PENNSYLVANIA STATE GRANT.

13. List below a complete statement of schools attended.

SECONDARY (HIGH) SCHOOL

School__________________________Address_________________________________________________Dates (from_______to_______)

School__________________________Address_________________________________________________Dates (from_______to_______)

COLLEGES OR OTHER INSTITUTIONS

(It is very important that you list all colleges or universities attended. The applicant must notify all colleges attended to mail an official

transcript of record directly to Duquesne University Office of Admissions.)

School__________________________Address_________________________________________________Dates (from_______to_______)

School__________________________Address_________________________________________________Dates (from_______to_______)

14. What special recognition, if any, have you received for excellence in school work, such as honors, prizes, scholarships:

___________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________

15. List school, church, civic, fraternal, recreational, business, professional, or similar organizations in which you have been active and

underline those in which you have held responsible positions:

___________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________

PLACE AN “X” BEFORE THE UNIVERSITY SCHOOL IN WHICH YOU DESIRE TO ENROLL

McAnulty College of Liberal Arts School of Education

Bayer School of Natural and A. J. Palumbo SchoolEnvironmental Sciences of Business Administration

John G. Rangos, Sr. Mary Pappert School of MusicSchool of Health Sciences

Mylan School of Pharmacy Student Special Interests:Pre Law

School of Nursing Pre-Health Profession

What is your vocational objective?

________________________________

________________________________

________________________________

________________________________

________________________________

________________________________

________________________________

________________________________

16. TALENT: Candidates should complete those sections which apply to their talents.Although you may not wish to audition in every category, state your experience, if any, in all categories.

Musical Instruments Played Date(s) From - To Teacher’s Name and Phone

List instrumental group memberships, any workshops or camps attended in last 4 years.

Dance Type Studied Date(s) From - To Teacher’s Name and Phone

List dance group memberships, any workshops or camps attended in last 4 years.

VOCAL: Indicate your voice range: Soprano Alto Tenor Bass

Type of voice training Date(s) of study Teacher’s Name & PhoneFrom - To

Choral experience - Choir or Chorus name No. of Years Director’s Name & Phone

18. CHARACTER REFERENCES. Give the names, complete addresses, and work and/or title of three people who can vouch for yourwork and character. Do not include relatives. Name at least one teacher.

Name _________________________________________________

Address _______________________________________________

City/State/Zip ___________________________________________

Phone _________________________________________________

E-mail _________________________________________________

Work/Title _____________________________________________

Name _________________________________________________

Address _______________________________________________

City/State/Zip ___________________________________________

Phone _________________________________________________

E-mail _________________________________________________

Work/Title _____________________________________________

Name _________________________________________________

Address _______________________________________________

City/State/Zip ___________________________________________

Phone _________________________________________________

E-mail _________________________________________________

Work/Title _____________________________________________

It is the policy of Duquesne University to admit applicants whoare best qualified to profit from opportunities which the Universityoffers for intellectual, spiritual, and social growth. In general,acceptance into the Tamburitzans program is based upon pastacademic performance, scholastic ability, personal characteristics,and overall dance, musical and vocal talent necessary to fillspecific or general vacant positions in the ensemble due tograduation or departure of current members. The Audition Paneldoes not take into consideration information about religiouspreferences, sexual orientation, racial characteristics or ethnic origins.

Attach Photograph Here

19. ALL CANDIDATES MUST:

1. Submit an essay of 100 words or less on the following subject: “Why I Want a College Education as a Tamburitzan”

2. Submit a recent photograph with this application (the picture cannot be returned)

I certify that all of this information is complete and accurate, and that I am notwithholding any information which should be known.

Signature ___________________________________________________________

Date _______________________________________________________________

12/02 .5M DIH