Please complete the following information to take the final steps towards your completion of either University or Departmental Honors.

1.	First Name:*

2.	Middle Name or Initial (if no middle name, write, NA)*

3.	Last Name:*

4.	Campus or Local Mailing Address:*

5.	City:*

6.	State:*

7.	Zip Code:*

8.	Student Email address 1: *

9.	Faculty Supervisor email address:*

10.	Faculty Supervisor Email Address:*

11.	Student Cell Phone Number (ex. 123-456-7890):*

12.	Check One: *
	University Honors ( honors basic studies and seminars)    Departmental Honors (DH work in major only)

13.	University Honors Only, Check All that apply
	I have taken at least 2 Honors 120's    I have taken at least 1 Honors 210    I have taken at least 12 Hours of Basic Studies in Honors    I have taken my honors 110 as a first semester freshman    I entered after first semester and have taken 9 Hours of Basic Studies in Honors

14.	GPA (Self-reported):

15.	Gender*
	male    female

16.	Ethnic Classification:
	American Indian/Alaskan Native    Asian    African American/Black not of Hispanic Origin    Hispanic/Latino    White, not of Hispanic origin    Other    No Response

17.	College Major 1:*

18.	College Major 2:

19.	College Minor 1:

20.	College Minor 2

21.	I will graduate:*
	Spring 2009    Fall 2009    Summer 1 2009    Summer 2 2009

22.	Have you submitted your application to the University for Graduation?*
	--Please Select--Yes No

23.	How many will attend the Honors Graduation Ceremony May 8th at 8:30 am in Burney with you?

24.	Do you, or anyone in your party, have any needs related to a disability?

25.	Have you had your headshot done in the Honors Office for your graduation picture? *
	--Please Select--Yes No

26.	what is the date, time and location of your defense?

27.	Is your defense open to the public?
	--None--Yes No

28.	Please enter your abstract for your paper here*

29.	Please enter the Title of your paper here

30.	Any other comments, questions, or concerns?

	Questions? 910-962-4181 - phone honors@uncw.edu - email