ESSEX HIGH SCHOOL

STUDENT SELF-REPORTED ACTIVITIES WORKSHEET

(For school use only. This form will not be included in your transcript packet.)

Student name __________________________________________

Extracurricular, Personal and Volunteer/Community Service Activities (including summer)
Please list your principal extracurricular, community and family activities and hobbies in the order of their interest
to you. Include specific events and/or major accomplishments such as a musical instrument played, varsity letter
earned, etc. Check () in the right column those activities you hope to pursue in college. To allow us to focus on
the highlights of your activities, please complete this section even if you attach a resume.
Grade level or post
secondary (p.s.)

Activity
9

10

11

12

Approximate time
spent
PS

Positions held, honors

won, or letters earned

Do you plan
to participate
in college?

Hours per Weeks

week
per year

Academic Honors
Briefly describe any scholastic distinctions or honors you have won beginning with ninth grade:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Work Experience
List any job (including summer employment) you have held during the last three years.
Specific Nature of Work

Employer

Approx. Dates
of employment

Approx. hours
per week