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2011-12 First-year Application

For Spring 2012 or Fall 2012 Enrollment

APPLICANT

Legal Name ___________________________________________________________________________________________________________________ Last/Family/Sur (Enter name exactly as it appears on official documents.) First/Given Middle (complete) Jr., etc. Preferred name, if not first name (only one) ____________________________ Former last name(s) _____________________________________________ Birth Date ____________________________________________________ US Social Security Number, if any ___________________________________ mm/dd/yyyy Required for US Citizens and Permanent Residents applying for financial aid via FAFSA Preferred Telephone p Home p Cell Home (_______) __________________________________ Cell (_______) __________________________________

Area/Country/City Code Area/Country/City Code

E-mail Address ________________________________________________ IM Address ____________________________________________________ Permanent home address __________________________________________________________________________________________________________ Number & Street Apartment #

____________________________________________________________________________________________________________________________ City/Town County or Parish State/Province Country ZIP/Postal Code If different from above, please give your current mailing address for all admission correspondence. (from ___________ to ___________)

(mm/dd/yyyy) (mm/dd/yyyy) Current mailing address __________________________________________________________________________________________________________ Number & Street Apartment #

____________________________________________________________________________________________________________________________ City/Town County or Parish State/Province Country ZIP/Postal Code If your current mailing address is a boarding school, include name of school here: _________________________________________________________________

FUTURE PLANS

Your answers to these questions will vary for different colleges. If the online system did not ask you to answer some of the questions you see in this section, this college chose not to ask that question of its applicants.

College ________________________________________________________ Deadline ______________________________________________________

mm/dd/yyyy

Entry Term: p Fall (Jul-Dec) p Spring (Jan-Jun)

Decision Plan ___________________________________________________ Academic Interests _____________________________________________ ____________________________________________________________ ____________________________________________________________ Career Interest _________________________________________________Do you intend to apply for need-based financial aid? p Yes p No Do you intend to apply for merit-based scholarships? p Yes p No Do you intend to be a full-time student? p Yes p No Do you intend to enroll in a degree program your first year? p Yes p No Do you intend to live in college housing? ______________________________

What is the highest degree you intend to earn? _________________________

DEmogRAPhICS p Female p Male

Citizenship Status ______________________________________________ Non-US Citizenship ______________________________________________ _____________________________________________________________ _____________________________________________________________ Birthplace ________________________________________________________ City/Town State/Province Country Years lived in the US? ____________ Years lived outside the US? __________ __

Language Proficiency (Check all that apply.)

S(Speak) R(Read) W(Write) F(First Language) H(Spoken at Home)S R W F H _______________________________________________ p p p p p _______________________________________________ p p p p p _______________________________________________ p p p p p Optional The items with a gray background are optional. No information you 1. Are you Hispanic/Latino?

p Yes, Hispanic or Latino (including Spain) p No If yes, please describe your background.

____________________________________________________________ 2. Regardless of your answer to the prior question, please indicate how you identify

yourself. (Check one or more and describe your background.)

p American Indian or Alaska Native (including all Original Peoples of the Americas) Are you Enrolled? p Yes p No If yes, please enter Tribal Enrollment Number________________ ____________________________________________________________ p Asian (including Indian subcontinent and Philippines)

____________________________________________________________ p Black or African American (including Africa and Caribbean)

____________________________________________________________ p Native Hawaiian or Other Pacific Islander (Original Peoples)

FAmILY

Please list both parents below, even if one or more is deceased or no longer has legal responsibilities toward you. Many colleges collect this information for demographic purposes even if you are an adult or an emancipated minor. If you are a minor with a legal guardian (an individual or government entity), then please list that information below as well. If you wish, you may list step-parents and/or other adults with whom you reside, or who otherwise care for you, in the Additional Information section. Household

Parents’ marital status (relative to each other): p Never Married p Married p Civil Union/Domestic Partners p Widowed p Separated p Divorced (date _________)

mm/yyyy With whom do you make your permanent home?p Parent 1 p Parent 2 p Both p Legal Guardian p Ward of the Court/State p Other

If you have children, how many? _________

Legal Guardian(if other than a parent)

Relationship to you _______________________________________________ ____________________________________________________________ Last/Family/Sur First/Given Middle Title (Mr./Mrs./Ms./Dr.) Country of birth ________________________________________________ Home address if different from yours

____________________________________________________________ ____________________________________________________________ Preferred Telephone: p Home p Cell p Work (_______) ________________

Area/Country/City Code

E-mail _______________________________________________________ Occupation _____________________________________________________ Employer _____________________________________________________ College (if any) ___________________________________ CEEB________ Degree _________________________________________ Year _________ Graduate School (if any) ____________________________ CEEB________Siblings

Please give names and ages of your brothers or sisters. If they are enrolled in grades K-12 (or international equivalent), list their grade levels. If they have attended or are currently attending college, give the names of the undergraduate institution, degree earned, and approximate dates of attendance. If more than three siblings, please list them in the Additional Information section.

____________________________________________________________ Name Age & Grade Relationship College Attended ___________________________________ CEEB _______ Degree earned _________________________ Dates __________________ or expected mm/yyyy – mm/yyyy

Parent 1:p Mother p Father p Unknown

Is Parent 1 living? p Yes p No (Date Deceased ____________________) mm/yyyy

____________________________________________________________ Last/Family/Sur First/Given Middle Title (Mr./Mrs./Ms./Dr.) Country of birth ________________________________________________ Home address if different from yours

____________________________________________________________ ____________________________________________________________ Preferred Telephone: p Home p Cell p Work (_______) ________________

Area/Country/City Code

Is Parent 2 living? p Yes p No (Date Deceased ____________________) mm/yyyy

____________________________________________________________ ____________________________________________________________ Preferred Telephone: p Home p Cell p Work (_______) ________________

Area/Country/City Code

EDUCATIoN

Secondary Schools

Most recent secondary school attended ______________________________________________________________________________________________ Entry Date _________________ Graduation Date _________________ School Type: p Public p Charter p Independent p Religious p Home School mm/yyyy mm/dd/yyyy

Address ________________________________________________________________________________ CEEB/ACT Code ___________________________ Number & Street

__________________________________________________________________________________________________________________________________ City/Town State/Province Country ZIP/Postal Code Counselor’s Name __________________________________________________________ C ounselor’s Title _______________________________________ E-mail _____________________________________ Telephone (_______) ______________________ Fax (_______) ________________________________

Area/Country/City Code Number Ext. Area/Country/City Code Number

List all other secondary schools you have attended since 9th grade, including summer schools or enrichment programs hosted on a secondary school campus: School Name & CEEB/ACT Code Location (City, State/Province, ZIP/Postal Code, Country) Dates Attended (mm/yyyy) _____________________________________________ _______________________________________________________ ____________________ _____________________________________________ _______________________________________________________ ____________________ _____________________________________________ _______________________________________________________ ____________________ Please list any community program/organization that has provided free assistance with your application process: ____________________________________________ If your education was or will be interrupted, please indicate so here and provide details in the Additional Information section: ___________________________________ Colleges & Universities Report all college attendance (including online) since 9th grade and indicate as College Course (CO) or Enrichment Program (EP) hosted on a college campus.

College/University Name & CEEB/ACT Code Location (City, State/Province, ZIP/Postal Code, Country) Degree Candidate? CO EP Dates Attended Degree Earned

Yes No mm/yyyy – mm/yyyy

_________________________________ ___________________________________________p p p p______________ _________ _________________________________ ___________________________________________p p p p______________ _________ _________________________________ ___________________________________________p p p p______________ _________ Were you issued a transcript for any work listed above?p Yes p No If yes, please have an official transcript sent as soon as possible.

ACADEmICS

The self-reported information in this section is not intended to take the place of your official records. Please note the requirements of each institution to which you are applying and arrange for official transcripts and score reports to be sent from your secondary school and the appropriate testing agencies. Where “Best Scores” are requested, please report the highest individual scores you have earned so far, even if those scores are from different test dates.

Grades Class Rank_________ Class Size _________ Weighted? p Yes p No GPA _________ Scale _________ Weighted? p Yes p No (if available) (if available)

ACT Exam Dates: ________ ________ ________ Best Scores: _________ ______ _________ ______ _________ ______ (past & future) mm/yyyy mm/yyyy mm/yyyy (so far) COMP mm/yyyy English mm/yyyy Math mm/yyyy

_________ ______ _________ ______ _________ ______

Reading mm/yyyy Science mm/yyyy Writing mm/yyyy SAT Exam Dates: ________ ________ ________ Best Scores: _________ ______ _________ ______ _________ ______ (past & future) mm/yyyy mm/yyyy mm/yyyy (so far) Critical Reading mm/yyyy Math mm/yyyy Writing mm/yyyy TOEFL/ Exam Dates: ________ ________ ________ Best Score: _________ ______ ______

IELTS(past & future) mm/yyyy mm/yyyy mm/yyyy (so far)Test Score mm/yyyy

AP/IB/SAT Subjects Best Scores: ________ __________________________________ _____ ________ __________________________________ _____ (per subject, so far) mm/yyyy Type & Subject Score mm/yyyy Type & Subject Score ________ __________________________________ _____ ________ __________________________________ _____ mm/yyyy Type & Subject Score mm/yyyy Type & Subject Score ________ __________________________________ _____ ________ __________________________________ _____ mm/yyyy Type & Subject Score mm/yyyy Type & Subject Score ________ __________________________________ _____ ________ __________________________________ _____ mm/yyyy Type & Subject Score mm/yyyy Type & Subject Score

Current Courses Please indicate title, level (AP, IB, advanced honors, etc.) and credit value of all courses you are taking this year. Indicate quarter classes taken in the same semester on the appropriate semester line.

Full Year/First Semester/First Trimester Second Semester/Trimester Third Trimester

or additional first/second term courses if more space is needed ________________________________________ ________________________________________ _________________________________________ ________________________________________ ________________________________________ _________________________________________ ________________________________________ ________________________________________ _________________________________________ ________________________________________ ________________________________________ _________________________________________ ________________________________________ ________________________________________ _________________________________________

Honors Briefly list any academic distinctions or honors you have received since the 9th grade or international equivalent (e.g., National Merit, Cum Laude Society). S(School) S/R(State or Regional N(National) I(International)

Grade level or post-graduate (PG)Honor Highest Level of

Recognition

9101112PG S S/R N I p p p p p_________________________________________________________________________________________________p p p p p p p p p_________________________________________________________________________________________________p p p p p p p p p_________________________________________________________________________________________________p p p p p p p p p_________________________________________________________________________________________________p p p p p p p p p_________________________________________________________________________________________________p p p p ExTRACURRICULAR ACTIvITIES & WoRk ExPERIENCE

Extracurricular Please list your principal extracurricular, volunteer, and work activities in their order of importance to you. Feel free to group your activities and paid work experience separately if you prefer. Use the space available to provide details of your activities and accomplishments (specific events, varsity letter, musical instrument, employer, etc.). To allow us to focus on the highlights of your activities, please complete this section even if you plan to attach a résumé.

Grade level or post-graduate (PG)Approximate

time spent

When did you participate

in the activity?

Positions held, honors won, letters earned, or employer

If applicable,

do you plan

to participate

in college?

9101112PG Hours Weeks School Summer/ School

WRITINg

Please briefly elaborate on one of your extracurricular activities or work experiences in the space below.

____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ Please write an essay of 250 – 500 words on a topic of your choice or on one of the options listed below, and attach it to your application before submission. Please indicate your topic by checking the appropriate box. This personal essay helps us become acquainted with you as a person and student, apart from courses, grades, test scores, and other objective data. It will also demonstrate your ability to organize your thoughts and express yourself. NOTE: Your Common Application

essay should be the same for all colleges. Do not customize it in any way for individual colleges. Colleges that want customized essay responses will ask for them on

a supplement form.

p 1 Evaluate a significant experience, achievement, risk you have taken, or ethical dilemma you have faced and its impact on you.

p 2 Discuss some issue of personal, local, national, or international concern and its importance to you.

p 3 Indicate a person who has had a significant influence on you, and describe that influence.

p 4 Describe a character in fiction, a historical figure, or a creative work (as in art, music, science, etc.) that has had an influence on you, and explain that influence. p 5 A range of academic interests, personal perspectives, and life experiences adds much to the educational mix. Given your personal background, describe an experience that illustrates what you would bring to the diversity in a college community or an encounter that demonstrated the importance of diversity to you. p 6 Topic of your choice.

Additional Information Please attach a separate sheet if you wish to provide details of circumstances or qualifications not reflected in the application. Disciplinary History

a Have you ever been found responsible for a disciplinary violation at any educational institution you have attended from the 9th grade (or the international equivalent)

forward, whether related to academic misconduct or behavioral misconduct, that resulted in a disciplinary action? These actions could include, but are not limited to: probation, suspension, removal, dismissal, or expulsion from the institution. p Yes p No

b Have you ever been adjudicated guilty or convicted of a misdemeanor, felony, or other crime? p Yes p No

[Note that you are not required to answer “yes” to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise ordered by a court to be kept confidential.]

If you answered “yes” to either or both questions, please attach a separate sheet of paper that gives the approximate date of each incident, explains the circumstances, and reflects on what you learned from the experience.

Note: Applicants are expected to immediately notify the institutions to which they are applying should there be any changes to the information requested in this application, including disciplinary history.

To ThE APPLICANT

After completing all the relevant questions below, give this form to a teacher who has taught you an academic subject (for example, English, foreign language, math, science, or social studies). If applying via mail , please also give that teacher stamped envelopes addressed to each institution that requires a Teacher Evaluation.

Legal Name ___________________________________________________________________________________________________________________

Last/Family/Sur (Enter name exactly as it appears on official documents.)

First/Given

Middle (complete)

Jr., etc.

Birth Date _______________________________________________________________

mm/dd/yyyy

Address ________________________________________________________________________________________________________________________

Number & Street Apartment #

City/Town

State/Province

Country

ZIP/Postal Code

School you now attend ________________________________________________________ CEEB/ACT Code _____________________________________To ThE TEAChER

The Common Application membership finds candid evaluations helpful in choosing from among highly qualified candidates. You are encouraged to keep this form in your private files for use should the student need additional recommendations. Please submit your references promptly, and remember to sign below before mailing directly to the college/university admission office. Do not mail this form to The Common Application offices.

Teacher’s Name (Mr./Mrs./Ms./Dr.) _______________________________________________ Subject Taught _______________________________________

Please print or type

Signature _________________________________________________________________________________________________ D ate _____________________

mm/dd/yyyy

Secondary School _______________________________________________________________________________________________________________School Address ________________________________________________________________________________________________________________

Number & Street

City/Town

State/Province

Country

ZIP/Postal Code

Teacher’s Telephone (_______) __________________________________________________ Teacher’s E-mail _____________________________________

Area/Country/City Code

Number

Ext.

Background Information

How long have you known this student and in what context? _______________________________________________________________________________ What are the first words that come to your mind to describe this student? _____________________________________________________________________In which grade level(s) was the student enrolled when you taught him/her? p 9 p 10 p 11 p 12 p Other_____________________________________List the courses in which you have taught this student, including the level of course difficulty (AP , IB, accelerated, honors, elective; 100-level, 200-level; etc.).

_______________________________________________________________________________________________________________________________

2011-12 Teacher Evaluation

For Spring 2012 or Fall 2012 Enrollment

p Female

p Male TE

Ratings

Compared to other students in his or her class year, how do you rate this student in terms of:

Below

Good (above very good (well above Excellent Outstanding One of the top few I’ve encoun-tered Evaluation Please write whatever you think is important about this student, including a description of academic and personal characteristics, as demonstrated in

your classroom. We welcome information that will help us to differentiate this student from others. (Feel free to attach an additional sheet or another reference you may have prepared on behalf of this student.)

To ThE APPLICANT

Legal Name ___________________________________________________________________________________________________________________

Last/Family/Sur (Enter name exactly as it appears on official documents.)

First/Given

Middle (complete)

Jr., etc.

Birth Date _______________________________________________________________

mm/dd/yyyy

Address ________________________________________________________________________________________________________________________

Number & Street Apartment #

City/Town

State/Province

Country

ZIP/Postal Code

School you now attend ________________________________________________________ CEEB/ACT Code _____________________________________To ThE TEAChER

Teacher’s Name (Mr./Mrs./Ms./Dr.) _______________________________________________ Subject Taught _______________________________________

Please print or type

Signature _________________________________________________________________________________________________ D ate _____________________

mm/dd/yyyy

Number & Street

City/Town

State/Province

Country

ZIP/Postal Code

Teacher’s Telephone (_______) __________________________________________________ Teacher’s E-mail _____________________________________

Area/Country/City Code

Number

Ext.

Background Information

_______________________________________________________________________________________________________________________________

2011-12 Teacher Evaluation

For Spring 2012 or Fall 2012 Enrollment

p Female

p Male TE

Ratings

Compared to other students in his or her class year, how do you rate this student in terms of:

Below

2011-12 SCHOOL REPORT

For Spring 2012 or Fall 2012 Enrollment

To ThE APPLICANT

After completing all the relevant questions below, give this form to your secondary school counselor or another school official who knows you better. If applying via mail , please also give that school official stamped envelopes addressed to each institution that requires a School Report.

Legal Name ___________________________________________________________________________________________________________________

Last/Family/Sur (Enter name exactly as it appears on official documents.)

First/Given

Middle (complete)

Jr., etc.

Birth Date ___________________________________________________

mm/dd/yyyy

Address ________________________________________________________________________________________________________________________

Number & Street Apartment #

City/Town

State/Province

Country

ZIP/Postal Code

School you now attend ________________________________________________________ CEEB/ACT Code _____________________________________Current year courses—please indicate title, level (AP , IB, advanced honors, etc.) and credit value of all courses you are taking this year. Indicate quarter classes taken in the same semester on the appropriate semester line.

Full Year/First Semester/First Trimester

Second Semester/Trimester

Third Trimester

or additional first/second term courses if more space is needed

________________________________________ ________________________________________ _________________________________________________________________________________ ________________________________________ _________________________________________________________________________________ ________________________________________ _________________________________________________________________________________ ________________________________________ _________________________________________________________________________________ ________________________________________ _________________________________________________________________________________ ________________________________________ _________________________________________________________________________________ ________________________________________ _________________________________________________________________________________ ________________________________________ _________________________________________To ThE SECoNDARY SChooL CoUNSELoR

Attach applicant’s official transcript, including courses in progress, a school profile, and transcript legend. (Check transcript copies for readability.) Use both pages to complete your evaluation for this student. Be sure to sign below before mailing directly to the college/university admission office. Do not mail this form to The Common Application offices.

Counselor’s Name (Mr./Mrs./Ms./Dr.) ________________________________________________________________________________________________

Please print or type

Signature _________________________________________________________________________________________________ D ate _____________________

mm/dd/yyyy

Title ___________________________________________________________ School _______________________________________________________School Address ________________________________________________________________________________________________________________

Number & Street

City/Town

State/Province

Country

ZIP/Postal Code

School Website Address _________________________________________________________________________________________________________p Female

p Male SR

Evaluation Please provide comments that will help us differentiate this student from others. Feel free to attach an additional sheet or another reference you have prepared for

this student. Alternatively, you may attach a reference written by another school official who can better describe the student. We especially welcome a broad-based assessment and encourage you to consider describing or addressing:

? The applicant’s academic, extracurricular, and personal characteristics.

? Relevant context for the applicant’s performance and involvement, such as particularities of family situation or responsibilities, after-school work obligations, sibling childcare, or other circumstances, either positive or negative.

? Observed problematic behaviors, perhaps separable from academic performance, that an admission committee should explore further.

Ratings Compared to other students in his or her class year, how do you rate this student in terms of:

a H as the applicant ever been found responsible for a disciplinary violation at your school from the 9th grade (or the international equivalent) forward, whether related

to academic misconduct or behavioral misconduct, that resulted in a disciplinary action? These actions could include, but are not limited to: probation, suspension, removal, dismissal, or expulsion from your institution. p Yes p No p School policy prevents me from responding

b T o your knowledge, has the applicant ever been adjudicated guilty or convicted of a misdemeanor, felony, or other crime?

p Yes p No p School policy prevents me from responding.

If you answered “yes” to either or both questions, please attach a separate sheet of paper or use your written recommendation to give the approximate date of each incident and explain the circumstances.

Applicants are expected to immediately notify the institutions to which they are applying should there be any changes to the information requested in this application, including disciplinary history.

Background Information

Below

Good (above very good

(well above Excellent Outstanding One of the top few I’ve encoun-tered How long have you known this student and in what context? _________________________________________________________________________________What are the first words that come to your mind to describe this student? ______________________________________________________________________

How many courses does your school offer:

AP _________ IB _________ Honors _________

If school policy limits the number a student may take in

a given year, please list the maximum allowed:

AP _________ IB _________ Honors _________

Is the applicant an IB Diploma candidate? p Yes p No

Are classes taken on a block schedule? p Yes p No In comparison with other college preparatory students

at your school, the applicant’s course selection is:p most demanding

p very demanding p demanding

p average

p below average

Class Rank ___________ Class Size ___________ Covering a period from __________ to __________.

(mm/yyyy) (mm/yyyy)

The rank is p weighted p unweighted. How many additional students share this rank? _________________ How do you report class rank? quartile _____________ quintile _____________ decile ______________Cumulative GPA: ________ on a _________ scale, covering a period from ____________ to ____________ (mm/yyyy) (mm/yyyy)

This GPA is p weighted p unweighted. The school’s passing mark is ________________________________.Highest GPA in class ____________________________________ Graduation Date ___________________ (mm/dd/yyyy)

Percentage of graduating class immediately attending: ___________four-year ________ two-year institutions

2011-12 OPTIONAL GRADE Report

For Spring 2012 or Fall 2012 Enrollment

TO THE APPLICANT

The Optional Grade Report may be used at any point in the academic year to submit updated grades to your colleges and universities, but it should not be used as a substitute for the Midyear or Final Report. After completing the information in this section, give this form to your school counselor or another school of?cial who knows you better. If applying via mail , please also give that school of?cial stamped envelopes addressed to each institution to which you have applied.

Legal Name ___________________________________________________________________________________________________________________

Last/Family/Sur (Enter name exactly as it appears on official documents.)

First/Given

Middle (complete)

Jr., etc.

Birth Date ___________________________________________________ CAID (Common App ID)_______________________________________________mm/dd/yyyy

Address ________________________________________________________________________________________________________________________

Number & Street Apartment #

City/Town

State/Province

Country

ZIP/Postal Code

School you now attend ________________________________________________________CEEB/ACT Code _____________________________________Counselor’s Name (Mr./Mrs./Ms./Dr.) ________________________________________________________________________________________________

Please print or type

Signature _________________________________________________________________________________________________ D ate _____________________

mm/dd/yyyy

Title ___________________________________________________________School _______________________________________________________School Address ________________________________________________________________________________________________________________

Number & Street

City/Town

State/Province

Country

ZIP/Postal Code

School Website Address _________________________________________________________________________________________________________Counselor’s Telephone (_______) ________________________________________ Counselor’s Fax (_______) _________________________________________

Area/Country/City Code

Number

Ext.

Area/Country/City Code

Number

School CEEB/ACT Code ____________________________________ Counselor’s E-mail _________________________________________________________

TO THE SCHOOL COUNSELOR

This form is not a substitute for the Midyear or Final Report. Please use this form only if you wish to update the applicant’s grades at another point in the year.

Attach the applicant’s of?cial transcript, including courses in progress and transcript legend. (Please check transcript copies for readability.) Be sure to sign below before mailing directly to the college/university admission of?ce. Do not mail this form to The Common Application of?ces.

? Female

? Male OR

Background Information If any of the information below has changed for this student since the School Report was submitted, please enter the new information in

the appropriate section below.

C lass Rank _______ Class Size ______ Covering a period from _______ to ______.

(mm/yyyy)

The rank is ? weighted ? unweighted.

How many additional students share this rank?__________

? We do not rank. Instead, please indicate quartile ____ quintile ____ decile ______

Cumulative GPA: _____ on a _____ scale, covering a period from _______ to ______.

(mm/yyyy)

This GPA is ? weighted ? unweighted. The school’s passing mark is _____________.Highest GPA in class _____________________ Graduation Date ________________

(mm/dd/yyyy)

Have there been any changes to the senior year courses listed on the original School Report? ? Yes ? No

Have there been any changes in the applicant’s disciplinary status at your school since you submitted the original School Report?? Yes ? No ? School policy prevents me from responding

To your knowledge, have there been any changes to the applicant’s criminal history since you submitted the original School Report?? Yes ? No ? School policy prevents me from responding

2011-12 MIDYEAR Report

For Spring 2012 or Fall 2012 Enrollment

To ThE APPLICANT

After completing the information in this section, give this form to your school counselor or another school official who knows you better. If applying via mail , please also give that school official stamped envelopes addressed to each institution to which you have applied.

Legal Name ___________________________________________________________________________________________________________________

Last/Family/Sur (Enter name exactly as it appears on official documents.)

First/Given

Middle (complete)

Jr., etc.

Birth Date ___________________________________________________

mm/dd/yyyy

Address ________________________________________________________________________________________________________________________

Number & Street Apartment #

City/Town

State/Province

Country

ZIP/Postal Code

School you now attend ________________________________________________________ CEEB/ACT Code _____________________________________Counselor’s Name (Mr./Mrs./Ms./Dr.) ________________________________________________________________________________________________

Please print or type

Signature _________________________________________________________________________________________________ D ate _____________________

mm/dd/yyyy

Number & Street

City/Town

State/Province

Country

ZIP/Postal Code

Area/Country/City Code

Number

Ext.

Area/Country/City Code

Number

School CEEB/ACT Code ____________________________________ Counselor’s E-mail _________________________________________________________

To ThE SChooL CoUNSELoR

Please submit this form when midyear grades are available (end of first semester or second trimester). Attach applicant’s official transcript, including courses in progress and transcript legend. (Please check transcript copies for readability.) Be sure to sign below before mailing directly to the college/university admission office. Do not mail this form to The Common Application offices.

p Female

p Male MR

Background Information If any of the information below has changed for this student since the School Report was submitted, please enter the new information in the appropriate section below.

C lass Rank _______ Class Size ______ Covering a period from _______ to ______.

(mm/yyyy) (mm/yyyy)

The rank is p weighted p unweighted.

How many additional students share this rank?__________

p We do not rank. Instead, please indicate quartile ____ quintile ____ decile ______

Cumulative GPA: _____ on a _____ scale, covering a period from _______ to ______.

(mm/yyyy) (mm/yyyy)

This GPA is p weighted p unweighted. The school’s passing mark is _____________.Highest GPA in class _____________________ Graduation Date ________________

(mm/dd/yyyy)

Have there been any changes to the senior year courses listed on the original School Report? p Yes p No

Have there been any changes in the applicant’s disciplinary status at your school since you submitted the original School Report? p Yes p No p School policy prevents me from responding

To your knowledge, have their been any changes to the applicant’s criminal history since you submitted the original School Report? p Yes p No p School policy prevents me from responding

Do you wish to update your original evaluation of this applicant? p Yes p No

If you responded yes to any of the preceding questions, please attach an explanation.

2011-12 final Report

For Spring 2012 or Fall 2012 Enrollment

To ThE APPLICANT

Legal Name ___________________________________________________________________________________________________________________

Last/Family/Sur (Enter name exactly as it appears on official documents.)

First/Given

Middle (complete)

Jr., etc.

Birth Date ___________________________________________________

mm/dd/yyyy

Address ________________________________________________________________________________________________________________________

Number & Street Apartment #

City/Town

State/Province

Country

ZIP/Postal Code

School you now attend ________________________________________________________ CEEB/ACT Code _____________________________________Counselor’s Name (Mr./Mrs./Ms./Dr.) ________________________________________________________________________________________________

Please print or type

Signature _________________________________________________________________________________________________ D ate _____________________

mm/dd/yyyy

Number & Street

City/Town

State/Province

Country

ZIP/Postal Code

Area/Country/City Code

Number

Ext.

Area/Country/City Code

Number

School CEEB/ACT Code __________________________________ Counselor’s E-mail __________________________________________________________

To ThE SChooL CoUNSELoR

Please submit this form when final grades are available (end of second semester or third trimester). Attach applicant’s official transcript and transcript legend. (Please check transcript copies for readability.) Be sure to sign below before mailing directly to the college/university admission office. Do not mail this form to The Common Application offices.

p Female

p Male FR

Background Information If any of the information below has changed for this student since the Midyear Report was submitted, please enter the new information

in the appropriate section below.

Have there been any changes to the senior year courses listed on the original School Report? p Yes p No

Have there been any changes in the applicant’s disciplinary status at your school since you submitted the original School Report? p Yes p No p School policy prevents me from responding

To your knowledge, have their been any changes to the applicant’s criminal history since you submitted the original School Report? p Yes p No p School policy prevents me from responding

Do you wish to update your original evaluation of this applicant? p Yes p No

If you responded yes to any of the preceding questions, please attach an explanation.

C lass Rank _______ Class Size ______ Covering a period from _______ to ______.

(mm/yyyy) (mm/yyyy)

The rank is p weighted p unweighted.

How many additional students share this rank?__________

p We do not rank. Instead, please indicate quartile ____ quintile ____ decile ______

Cumulative GPA: _____ on a _____ scale, covering a period from _______ to ______.

(mm/yyyy) (mm/yyyy)

This GPA is p weighted p unweighted. The school’s passing mark is _____________.Highest GPA in class _____________________ Graduation Date ________________

(mm/dd/yyyy)