Personal Questionnaire Personal InformationName First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneEmail* Your login information needed to access your Student Services will be sent to this email address.Academic BackgroundName the high school that you graduated from, including the city and country.* List your academic standing (GPA)Be advised that you need to provide the university with transcripts / proof of academic standing. List your academic achievements / special awardsCheck all that apply: Athletics Music Employment Committees Volunteer Groups Outreach Programs Member of any Championship Teams Participation in any National Competitions Participation in any International Competitions Other Please give us information on your achievements in AthleticsPlease give us information on your achievements in MusicPlease give us details on your Employment HistoryPlease give us details on Commitees you have belonged toPlease give us details on the Volunteer Groups you have been active withPlease give us details on the Outreach Programs you have participated inName the Championship Teams you belonged toWhat National Competitions have you participated inWhat Interational Competitions have you participated inPlease give us information on your other qualificationsPersonal HistoryIs there someone in your life who has motivated you to purse your education / dreams? Why?*List 3 characteristics that people would use to describe you and give examples of how these would apply to you.*List any personal, physical or emotional challenges that you have had to overcome in your life.List any personal, physical or emotional challenges that a family member has had to overcome in their lives, that has motivated you.List your immediate goals.*List your long-term goals.*List any other information about yourself that you think is important to highlight.*Student NumberComplete this section if you have purchased a University Application GuideHow many Universities are you applying to: 3 6 Choice #1University City CountryCanadaUnited StatesChoice #2University City CountryCanadaUnited StatesChoice #3University City CountryCanadaUnited StatesChoice #4University City CountryCanadaUnited StatesChoice #5University City CountryCanadaUnited StatesChoice #6University City CountryCanadaUnited StatesThis information will be saved into your Kessinger Consulting account. In the meantime, if you'd like to keep a copy for your records please print this page.
