tHE COMMON APPLICATION 2010-11 SECONDARY SCHOOL REPORT SR For Spring 2011 or Fall 2011 Enrollment TO THE APPLICANT ‘ter completing al the relevant questons below, give this form to your secondary school counselor or another school official who knows you batter. W applying via mall, please also ge that school official stamped envelopes addressod to each institution that requires @ Secondary School Repor. Legal Name asaya ae aay wT apa aT eacananis) RSTn Ti Tre Birth Date Social Security # Ta ‘ona ders, ‘School you now attend CEEBIACT Code Current year courses—please indicat tile, level (AP IB, advanced honors, et.) and credit value of all courses you are taking tis ye ‘lasses taken in the same semester on the appropriate semester line, First SomesterTimester Second Somesterrimester ‘Third Trimester Indicate quarter IMPORTANT PRIVACY NOTE: By signing this form, | authorize al schools that | have attended to release al requested cords covered under th Federal Educational Rights and Privacy Act (FERPA) so that my application may be reviewed by the Common Application member instution(s) to which !2m applying. |urther authorize the admission officers reviewing my application, induding seasonal staf employed forthe sole purpose of evaluating application, to contact offeias at my current and former schools should ty nave questions about the schol forms submitted on my bell | understand that under the terms ofthe FERPA, afte | marculate | vl have access to this frm and al other recommendations and supporting documents submited by me and on my behalf, unless at least one of the following is tue 1. The instutlon doesnot save recommendations post-maticulton (se lit at warw.commongpp.org/FERPA. 2Iwalve my ight to access belo, regarclss ofthe institution to which tis sen: Le, do waive my right to access, and | undestan | il never see this form or any other recommendations submited by me or on my behal Eo, not naivemy right to access, and | may someday choose to soe this fom or any ater recommendations or supporting documents submited by me or ‘on my behalf tothe institution at which 'm enoling, if that instution saves them after I matrcuate Required Signature Date. TO THE SECONDARY SCHOOL COUNSELOR ‘tach aplcant’ ofl transcrip, including courses progres, a school pole, and transit legend, (Check transcript copies for readabilty) Use both pages to ‘complete your evaluation for his student. Be sure to sign below. Counselor's Name (MMs /Or, ets) ‘Signature SS Date, Te Schoo! ‘Shoo Addr ‘own Satronnee ——— Gaanry Peal Cae Counselors Telephone (_) Counselor's Fax (_) ‘aoa oor Cote Tamter fi ‘Aral Cade Taber ‘Secondary schol CEEBVACT code (counselor's €-mal 2010 cana ser, smivanreyBackground Information (as Rank Gis Sie Covering a pid ta » How many courses does your sco oer ‘anim Teme 8 Honors The rank is Cl weightee "unweighted. How many students share his rank? schol poly mis he number a student ray ke, please Et theracinam alowed C1 we do not rank. instead, please indicate quartile ‘quintile decile ____B___ Honors _ Is te aplentan Diploma cant: ]Ye_1No Cornlave GPA: ona sz, coreing a prod ton _'©____ gas ona soe] 0 tnoomgaron wth oer ca tuts Tis GPA sLveigted "Junneightad he schets passing mark is a arc spartan a most emanting Highest Ain class ——Greuaton ap __ F]tanani Percentage of graduating cass immediately attending Jourjear two-year insituions Somers Below average Howr lng have you known this student andin what context? ‘Wat are the fist mords that come to your mind to desenibe this student? Ratings Compared to othr students in his or her class year, how do you rate this student in terms of: ory good (ne ofthe top fow Good (above (well above Excellent Outstanding Te encountered No base Below average Average average) _ average) _(top 10%) top 5%)__—— (op 1%), Academic achievement Eracuricular acompishments Personal qualtes and charecter OVERALL Evaluation Please provid commen thal will help us dflerentit his student fom oer. Fal eet tach anata sheet or another erence you've prepa fortis student We especialy welcome a broai-based assessment and encourage yu to cansier describing or aessng +The applicants acai, extacuricul, and persona characterises. + Relevant context forthe applicants performance andinvleren, sch as partcularias of amily tuto or responsi ter-echoo werk obligations, sing childcare, other circumstances, ether postive or negate + Observed prblematc behaviors perhaps separable fom academic performance tht an admission commie should explore further. (© Has the appcant ever been found responsible for a dscpinary violation at your schoo tom 9 grade (or the interational equivalent forward whether related to ‘academic misconduct or behavioral misconduct, that reste in the applicants probation, suspension, removal, clsmssl or expulsion rom your stu _ Yes _]No @ To your iowladge, has the aplicant ever been adjutcated gut or convicted of amisdemeanc, elon oF other crime? [Yes ] No {Note thal you arent required to answer "ys" to this question, or provide an explanation if te criminal achuication or conviction nas been expunged, sealed, ‘annulled, parconed, destroyed, erased, impounded, or otherwise ordered tobe Kept conidential by a court) Iryou answered “yes” to elteror both question, please attach a separate sheet of paper or use your written recammendation to give the approximate date of each Incident and explain te cxcumstances. check here it you would prefer to discuss this applicant over the phone with each admission offic. {recommend this student: [-] No basis with reservation [) Faity strongly [) Stongly []Enthusiastclly © 2010 Commer Apr, savant