Name: _________________________________________________________________________________________
                                  First                                            Middle                                            Last

Current Address: ________________________________________________________________________________
                                                                                 Street Address

City _________________________   State/Province/Country _________________  Zip/Postal Code  _____________

Telephone number: (_____)________________ e-mail: _________________________________________________

Date of Birth: ____/____/____

College or university: _____________________________________________________________________________

High School currently attending: ____________________________________________________________________

GPA: _________ Class ranking: _________

Extracurricular activities at High School:  

________________________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Community activities (Thalia or local Hampton Roads community):

________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

On separate sheets, please provide the following:

1) An original (signed) letter of reference from a teacher or a faculty member.
2) An original (signed) letter of reference from an adult not related to the applicant.
3) An original essay entitled “Growing up and living in Thalia”.

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