First Name (required)

Last Name (required)

Student ID# (required)

Street Address

City

State (Must be a District of Columbia Resident)

Zip Code

Phone Number (required) ###-###-####

Your Email (required) ex: John.Smith@udc.edu

Education Information

Major (required)

Cumulative GPA (required)

Classification (required)
—Please choose an option—JuniorSenior

Requirements

Are you a U.S.Citizen

YesNo

Are you a D.C. Resident

YesNo

Essay Requirement

Highlight your leadership qualities, community service activities, abilities and talents, and future aspiration

Letter of Recommendation from Professor

Signature (required)

Date

* Must be available for an interview by a committee of Altrusa members *

Δ