Revised 7/1/19
MT. SAN JACINTO COLLEGE HONORS ENRICHMENT PROGRAM APPLICATION FORM
Part I: Personal Information
Name: ___________________________________ Preferred Name ___________________________
Mailing Address: ____________________________________________________________________
Number and Street City, State, Zip
________________ ___________________________ ___________________________
Cell Phone Number MSJC Email Address Personal Email Address
Note: Your signature here authorizes college personnel to verify your coursework and GPA for courses taken at MSJC.
_______________________________________________ ____________________________ ______________
Signature Authorizing Electronic Verification Student ID# Date
Part II: Status of Applicant
All applications must include:
1. Transcripts (unofficial college or official high school)
2. Personal statement
3. Education Plan or list of several classes that the student can take as honors
4. Evidence of enrollment in or completion of English 101 (via transcript) or signed pledge
indicating planned enrollment in English 101 during first semester in the program (included at
end of application).
SELECT ONE OF THE FOLLOWING OPTIONS TO APPLY TO HONORS (Check and complete one)
Recommendation and Meeting Option
A letter of recommendation from a teacher,
counselor or principal familiar with your academic
work. The letter should specifically reference your
critical thinking skills.
Brief meeting with one of the Honors Co-Directors.
Portfolio and Meeting Option
Portfolio of work that includes a minimum of
3 items that demonstrate your academic
potential. Items in portfolio may include (but
are not limited to) writing samples, artwork,
performance pieces, news reports,
multimedia presentation, etc.
Brief meeting with one of the Honors Co-
Directors.
Qualifying GPA and Contact Names
Transcript must indicate qualifying GPA (3.5
unweighted GPA for High School, or 3.3 GPA for
College-level coursework), or better unweighted
GPA or SAT 1890 (out of 2400), or SAT 1260 (out
of 1600) or ACT 28 (out of 36).
Names and contact information of two MSJC
faculty members who will comment on behalf of
your application to the program (letters of
recommendation not required)
Name/Email__________________________________
Name/Email__________________________________
Veteran Status
Veteran or Active Duty in the US Military.
Signature of MSJC Veterans Center Staff or
Faculty
Signature _____________________________
For program use only
Date Accepted: _________
Colleague: _____________
Email: _________________
Canvas: ______________
Gazette: ______________
Database: _____________
Notes:
click to sign
signature
click to edit
click to sign
signature
click to edit
Revised 7/1/19
Part III: Questionnaire
What is your major or anticipated major: ______________________________________________
Are you planning on transferring or entering the workforce upon completion at MSJC: __________
If you are planning on transferring, what are your top 3 transfer institutions?
_________________, ____________________, ___________________
While we encourage all students to complete the honors program, completion is not required for
membership. At time of application, are you planning on completing the Honors Enrichment Program (see
list of requirements on page 3) Yes _________ No ___________
List the five courses you plan on taking to complete the honors program. (www.msjc.edu/honors)
____________________, _____________________, ___________________, ____________________,
_____________________
How did you find out about the program? ___________________________________________________
From which high school (include city) did you graduate?
____________________________________________________________________________________
Part IV: Personal Statement
The Honors Enrichment Program core values are inclusivity, leadership, academic rigor and research,
engagement, positive transgressive behavior (as evidenced by creativity, innovation, risk taking, challenging norms
and standard narratives), and holistic well-being. Which of these value or values resonates with you, and what have
you done or what do you want to do that somehow relates to this value or these values? The statement should be
typed, a minimum of 250 words, and attached to the completed application.
Part V: Program Expectations
By submitting this application, you are agreeing (should you be accepted into the Honors Enrichment Program) to
the following:
1. Maintaining a 3.3 GPA while in the Honors Program and a 3.0 GPA in Honors classes.
2. The completion of at least one honors class per semester beginning the first full semester the student is in
the program (students may petition for a one semester reprieve from this requirement due to extenuating
circumstances).
3. Recognition that the Honors Enrichment Program does not guarantee that all students will be able to
complete the Honors Enrichment Program.
4. Following acceptance into the Honors Program, each new Honors Program student is required to schedule
an academic counseling session with one of the Honors Program counselors. Thereafter, academic
counseling appointments must be scheduled once each semester with the Honors Counselor.
5. All honors students are expected to abide by the Mt. San Jacinto College Student Code of Conduct.
Failure to meet these requirements will result in the student being placed on probation for a semester to allow them
to improve their standing or risk dismissal from the program.
__________________________________________ _________________
Signature of Student Date
click to sign
signature
click to edit
Revised 7/1/19
Part VI: Further Instructions for Applicants
_____ (please initial after reading)
In order to complete the Honors Enrichment Program at Mt. San Jacinto College, Honors students must complete a
minimum of 5 Honors classes worth 15 units. Of these classes one must be the HEP Honors Studies Course (201,
202, or 203) and the other 4 must be in a minimum of three different disciplines. Students will maintain a 3.3 overall
GPA and a 3.0 Honors GPA. Completing students will have passed or tested out of English 101 or 101H and pass
or tested out of Math 96. Completing students will also have completed an exit survey and 200 points of Honors
Activity Points (see Canvas course shell for qualifying events).
_____ (please initial after reading)
Students who are members in good standing in the Honors Enrichment Program will usually receive Priority 5
registration as per the MSJC College Catalog. However, early registration is not guaranteed by the Honors
Enrichment Program and usually only becomes available after the student has been a member of the program for a
full semester.
_____ (please initial after reading)
Acceptance into the program is dependent on a variety of criteria such as the following: qualifying GPA, quality of
the letter of recommendation or references, the quality of the personal statement, the student’s portfolio, veteran’s
status, meeting with Honors Co-Director’s and the suitability of the Honors Program for the student’s
academic/career path.
Honors Program applications are accepted year-round. Applications will be reviewed shortly after the following
enrollment window deadlines:
Friday of the First Week of August Friday of the Second Week of February
Friday of the Second Week of September Friday of the First Week of May
Friday of the Third Week of November Friday of the Second Week of June
Friday of the First Week of January
Acceptance letters will be emailed following review and approval by an Honors Program Coordinator. If you have
questions, please contact Erik Ozolins, MVC Coordinator at 951-639-5725 (eozolins@msjc.edu) or Christina
Yamanaka, SJC Coordinator at 951-487-3522, (cyamanaka@msjc.edu).
PLEASE SUBMIT THIS FORM AND ALL REQUIRED MATERIAL TO
For MVC
Erik Ozolins
MVC Honors Program Coordinator
Mt. San Jacinto College
28237 La Piedra Rd.
Menifee, CA 92584
For SJC
Christina Yamanaka
SJC Honors Program Coordinator
Mt. San Jacinto College
1499 N. State Street
San Jacinto, CA 92583
Completed applications and supporting materials may also be turned in at the Learning Resource Center on either
campus, Erik’s office (MVC -Room 456), or Christina’s office (SJC – Room 1503) or to Honors Staff at either Honors
Space (Room 1253 at SJC or Room 830 at MVC). If you submit your application to the LRC, please be sure to email the
appropriate Honors Coordinator to let them know your application has been turned in.
English 101 Pledge
□ I have fulfilled the English 101 requirement by passing English 101 with a grade of C or
higher, taking the equivalent at another college, or have placed into a higher level English
class.
□ I pledge to take ENG 101 during the first semester of the program
________________________________________ ______________________________
Signature Date
click to sign
signature
click to edit
Revised 7/1/19
MT. SAN JACINTO COLLEGE PHOTO RELEASE FORM
Honors Applicants
Periodically we take photographs of our Honors members during Honors classes and Honors events. We use these
photographs to help us advertise the program and educate our local community about the goals and benefits of
Honors. If you are accepted into the program, we may have the opportunity of photographing you. If you are
willing to allow us to use your image in Honors media materials, please consider reading and signing the MSJC
photo release form below. Signing the photo release form is optional and does not influence our evaluation of your
application.
Photo Release (Check one of the two boxes listed below)
I, the undersigned, give Mt. San Jacinto College permission to use my photo, video image, and/or voice for
advertising, marketing, or editorial purposes. I hereby release, waive and hold harmless any and all claims arising
out of the use of said image, voice, related story or editorial by the College and/or its authorized designee, such as
cable or network TV stations, radio stations, newspapers, magazines or other printed publication, or for use in a
college brochure, catalog, schedule of classes, advertisement, promotion, documentary, feature story or film.
I warrant that I am at least eighteen (18) years of age. If I am under the age of eighteen (18), this form must be
signed by a parent or guardian. I have read and fully understand the above statements.
________________________________________ ______________________________
Print Name Date
________________________________________________
Signature
________________________________________________
Signature of Parent or Guardian if under age 18
________________________________________________
Address
_____________________________________________________________________________
City, State, Zip
_______________________ ____________________________________
Phone E-mail address
I do not wish to sign the MSJC Photo Release form at this time.
click to sign
signature
click to edit
click to sign
signature
click to edit
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome