First Name:* Last Name:* College ID#:* Address:* City:* State:* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip:* Phone:* Email:* Expected Graduation Date:* Please list all honors achieved, club memberships, extracurricular activities, leadership positions held, community service participation and special recognition received:* Write a 250-500 word essay describing your academic and professional goals. Discuss how having your own computer will help you to succeed at Atlantic Cape:*

I hereby authorize the Selection Committee, their representatives, and members of the Foundation Board to review my academic records and pertinent information for the purpose of consideration for the Collegiate Computers Program and award tracking.*

I intend to enroll as a full-time student (minimum of 12 credits) at Atlantic Cape Community College for the fall 2013 semester.*