2010-11 First-year Application

For Spring 2011 or Fall 2011 Enrollment

APPLIC ANT
Legal Name ___________________________________________________________________________________________________________________
Last/Family/Sur (Enter name exactly as it appears on official documents.)

First/Given

Middle (complete)

Jr., etc.

Preferred name, if not rst name (choose only one) ______________________

Former last name(s), if any _______________________________________

Birth Date ____________________________________________________

Female
Male

US Social Security Number, if any ___________________________________

mm/dd/yyyy

Optional, unless applying for US Federal financial aid with the FAFSA form

Preferred Telephone
Home
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

If different from above, please give your current mailing address for all admission correspondence.

ZIP/Postal Code

(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:
Fall (Jul-Dec)

Spring (Jan-Jun)

Do you intend to apply for need-based nancial aid?

Yes
No

Decision Plan___________________________________________________

Do you intend to apply for merit-based scholarships?

Academic Interests _____________________________________________

Do you intend to be a full-time student?

____________________________________________________________

Do you intend to enroll in a degree program your rst year?

Yes
No

Yes
No

Yes
No

____________________________________________________________

Do you intend to live in college housing? ______________________________

Career Interest _________________________________________________

What is the highest degree you intend to earn? _________________________

DEMOGRAPHICS
Citizenship Status ______________________________________________

1. Are you Hispanic/Latino?

Non-US Citizenship ______________________________________________

Yes, Hispanic or Latino (including Spain)
No

_____________________________________________________________
_____________________________________________________________
Years lived in the US? ____________________________________________
Birthplace ________________________________________________________
City/Town

State/Province

Country

First Language _________________________________________________

Primary language spoken at home _____________________________________
Are you procient in any other languages? _______________________________
_________________________________________________________________
Optional The items with a gray background are optional. No information you
provide will be used in a discriminatory manner.
Marital Status ____________________________________________________
Religious Preference _______________________________________________
US Armed Services veteran?
Yes
No

2010 The Common Application, Inc.

Please describe your background ________________________________________________

2. Regardless of your answer to the prior question, please indicate how you identify
yourself. (Check all that apply.)

American Indian or Alaska Native (including all Original Peoples of the Americas)
Are you Enrolled?
Yes
No If yes, please enter Tribal Enrollment Number________________
Please describe your background ________________________________________________

Asian (including Indian subcontinent and Philippines)

Please describe your background ________________________________________________

Black or African American (including Africa and Caribbean)

Please describe your background ________________________________________________

Native Hawaiian or Other Pacic Islander (Original Peoples)

Please describe your background ________________________________________________

White (including Middle Eastern)

Please describe your background ________________________________________________

AP-1 / 2010-11

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):
Never Married
With whom do you make your permanent home?

Parent 1

Married

Parent 2

Widowed

Both

Separated

Legal Guardian

Divorced (date ________________________)

Ward of the Court/State

mm/yyyy

Other

Parent 1:
Mother
Father
Unknown

Is Parent 1 living?
Yes
No (Date Deceased ____________________)

Parent 2:
Mother
Father
Unknown

Is Parent 2 living?
Yes
No (Date Deceased ____________________)

____________________________________________________________

____________________________________________________________

Last/Family/Sur

Last/Family/Sur

mm/yyyy

First/Given

Middle

Title (Mr./Ms./Dr., etc.)

mm/yyyy

First/Given

Middle

Title (Mr./Ms./Dr., etc.)

Country of birth ________________________________________________

Country of birth ________________________________________________

Home address if different from yours

Home address if different from yours

____________________________________________________________

____________________________________________________________

____________________________________________________________
Preferred Telephone:
Home
Cell
Work

____________________________________________________________
Preferred Telephone:
Home
Cell
Work

(_______) ____________________________________________________

(_______) ____________________________________________________

Area/Country/City Code

Area/Country/City Code

E-mail _______________________________________________________

E-mail _______________________________________________________

Occupation _____________________________________________________

Occupation _____________________________________________________

Employer _____________________________________________________

Employer _____________________________________________________

College (if any) ___________________________________ CEEB ________

College (if any) ___________________________________ CEEB ________

Degree _________________________________________ Year _________

Degree _________________________________________ Year _________

Graduate School (if any) ____________________________ CEEB ________

Graduate School (if any) ____________________________ CEEB ________

Degree _________________________________________ Year _________

Degree _________________________________________ Year _________

Legal Guardian

Siblings

(if other than a parent)

Relationship to you _______________________________________________

____________________________________________________________
Last/Family/Sur

First/Given

Middle

Title (Mr./Ms./Dr., etc.)

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.

Home address if different from yours

____________________________________________________________
____________________________________________________________
____________________________________________________________
Preferred Telephone:
Home
Cell
Work
(_______) ____________________________________________________

Name

Age & Grade

Relationship

College Attended ___________________________________ CEEB _______

Degree earned _________________________ Dates __________________
mm/yyyy mm/yyyy
or expected

Area/Country/City Code

____________________________________________________________

E-mail _______________________________________________________

Name

Occupation _____________________________________________________

Age & Grade

Relationship

College Attended ___________________________________ CEEB _______

Employer _____________________________________________________

Degree earned _________________________ Dates __________________

mm/yyyy mm/yyyy
or expected

College (if any) ___________________________________ CEEB ________

____________________________________________________________

Degree _________________________________________ Year _________

Name

Age & Grade

Relationship

College Attended ___________________________________ CEEB _______

Graduate School (if any) ____________________________ CEEB ________

Degree _________________________________________ Year _________

2010 The Common Application, Inc.

Degree earned _________________________ Dates __________________

mm/yyyy mm/yyyy
or expected
AP-2 / 2010-11

EDUC ATION
Secondary Schools
Current or most recent secondary school attended ______________________________________________________________________________________
Entry Date _________________ Graduation Date _________________
mm/yyyy

Public
Charter
Independent
Religious
Home School

School Type:

mm/dd/yyyy

Address ________________________________________________________________________________ CEEB/ACT Code ___________________________

Number & Street

__________________________________________________________________________________________________________________________________
City/Town

State/Province

Country

ZIP/Postal Code

Counselors Name (Mr./Ms./Dr., etc.) ____________________________________________ Counselors Title _______________________________________

E-mail _____________________________________ Telephone (_______) ______________________ Fax (_______) ________________________________
Area/Country/City Code

Number

Ext.

Area/Country/City Code

Number

th

List all other secondary schools you have attended since 9 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 List all colleges you have attended since 9th grade, including summer schools or enrichment programs hosted on a college campus:
College/University Name & CEEB/ACT Code

Location (City, State/Province, ZIP/Postal Code, Country) Degree Candidate?

Yes No

_________________________________ ___________________________________________
_________________________________ ___________________________________________
_________________________________ ___________________________________________

Dates Attended
mm/yyyy mm/yyyy

Degree Earned

__________________ __________________
__________________ __________________
__________________ __________________

AC ADEMICS
The self-reported information in this section is not intended to take the place of your ofcial records. Please note the requirements of each institution to which you are
applying and arrange for ofcial 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?
Yes
No
GPA _________ Scale _________ Weighted?
Yes
No
(if available)

ACT

(if available)

Exam Dates: ________ ________ ________

Best Scores: _________ ______

(past & future)

(so far)

mm/yyyy

mm/yyyy

mm/yyyy

COMP

mm/yyyy

_________ ______
Reading

SAT
TOEFL/
IELTS

mm/yyyy

Exam Dates: ________ ________ ________

Best Scores: _________ ______

(past & future)

(so far)

mm/yyyy

mm/yyyy

mm/yyyy

Critical Reading

mm/yyyy

_________ ______
English

_________ ______
Science

Exam Dates: ________ ________ ________

Best Score: _________ ______ ______

(past & future)

(so far)

mm/yyyy

mm/yyyy

mm/yyyy

Test

AP/IB/SAT Best Scores: ________ __________________________________ _____

Type & Subject
Score
Subjects (per subject, so far) mm/yyyy
________ __________________________________ _____
mm/yyyy

Type & Subject

Score

________ __________________________________ _____

mm/yyyy

Type & Subject

Score

________ __________________________________ _____

mm/yyyy

Type & Subject

Score

Score

mm/yyyy

_________ ______
Math

_________ ______

mm/yyyy

mm/yyyy

Math

mm/yyyy

_________ ______
Writing

mm/yyyy

_________ ______
Writing

mm/yyyy

mm/yyyy

________ __________________________________ _____

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.
First Semester/Trimester

Second Semester/Trimester

Third Trimester
or additional rst/second term courses if more space is needed

________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________

2010 The Common Application, Inc.

________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
________________________________________

_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
_________________________________________
AP-3 / 2010-11

Honors Briey list any academic distinctions or honors you have received since the 9 th grade or international equivalent (e.g., National Merit, Cum Laude Society).
Grade level or
post-graduate (PG)

Honor

10

11

12

PG

Level of Recognition
School State/ National InterRegional
national

_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

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 (specic 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 rsum.
Grade level or
post-graduate (PG)
9

10

11

12

Approximate
time spent
PG

Hours
per week

When did you participate

in the activity?
Summer/
Weeks School School
per year
year
Break

Positions held, honors won, letters earned, or employer

If applicable,
do you plan
to participate
in college?

________________________________________________________________

Activity _________________________________________________________________________________________________________________

________________________________________________________________

Activity _________________________________________________________________________________________________________________

________________________________________________________________

Activity _________________________________________________________________________________________________________________

________________________________________________________________

Activity _________________________________________________________________________________________________________________

________________________________________________________________

Activity _________________________________________________________________________________________________________________

________________________________________________________________

Activity _________________________________________________________________________________________________________________

________________________________________________________________

Activity _________________________________________________________________________________________________________________

________________________________________________________________

Activity _________________________________________________________________________________________________________________

________________________________________________________________

Activity _________________________________________________________________________________________________________________

________________________________________________________________

Activity _________________________________________________________________________________________________________________

________________________________________________________________

Activity _________________________________________________________________________________________________________________

________________________________________________________________

Activity _________________________________________________________________________________________________________________

2010 The Common Application, Inc.

AP-4 / 2010-11

WRITING
Short Answer Please briey elaborate on one of your extracurricular activities or work experiences in the space below or on an attached sheet (150 words or fewer).
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________

Personal Essay Please write an essay (250 words minimum) 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.






Evaluate a signicant experience, achievement, risk you have taken, or ethical dilemma you have faced and its impact on you.
Discuss some issue of personal, local, national, or international concern and its importance to you.
Indicate a person who has had a signicant inuence on you, and describe that inuence.
Describe a character in ction, a historical gure, or a creative work (as in art, music, science, etc.) that has had an inuence on you, and explain that inuence.
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.
 Topic of your choice.

Additional Information If there is any additional information youd like to provide regarding special circumstances, additional qualications, etc., please do so in the
space below or on an attached sheet.
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________

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

forward, whether related to academic misconduct or behavioral misconduct, that resulted in your probation, suspension, removal, dismissal, or expulsion from
the institution?
Yes
No
 Have you ever been adjudicated guilty or convicted of a misdemeanor, felony, or other crime?
Yes
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 condential.]
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
reects on what you learned from the experience.

SIGNATURE
Application Fee Payment If this college requires an application fee, how will you be paying it?

Online Payment
Will Mail Payment
Online Fee Waiver Request
Will Mail Fee Waiver Request
Required Signature
I certify that all information submitted in the admission process-including the application, the personal essay, any supplements, and any other supporting
materials-is my own work, factually true, and honestly presented, and that these documents will become the property of the institutions to which I am applying
and will not be returned to me. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation, expulsion, or
revocation of course credit, grades, and degree should the information I have certied be false.
I acknowledge that I have reviewed the application instructions for each college receiving this application. I understand that all offers of admission are conditional,
pending receipt of nal transcripts showing work comparable in quality to that upon which the offer was based, as well as honorable dismissal from the school.
I afrm that I will send an enrollment deposit (or equivalent) to only one institution; sending multiple deposits (or equivalent) may result in the withdrawal of my
admission offers from all institutions. [Note: students may send an enrollment deposit (or equivalent) to a second institution where they have been admitted from
the waitlist, provided that they inform the rst institution that they will no longer be enrolling.]
Signature _______________________________________________________________________________________________ Date ___________________
mm/dd/yyyy

Common Application member institution admission offices do not discriminate on the basis of race, color, ethnicity, national origin, religion, creed, sex,
age, marital status, parental status, physical disability, learning disability, political affiliation, veteran status, or sexual orientation.

2010 The Common Application, Inc.

AP-5 / 2010-11

TE

2010-11 Teacher Evaluation

For Spring 2011 or Fall 2011 Enrollment

TO THE APPLIC ANT

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.

Female
Legal Name ___________________________________________________________________________________________________________________

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

First/Given

Middle (complete)

Jr., etc.

Birth Date __________________________________________________________________ Social Security # _____________________________________

mm/dd/yyyy

(Optional)

Address ________________________________________________________________________________________________________________________
Number & Street

Apartment #

City/Town

State/Province

Country

ZIP/Postal Code

School you now attend ________________________________________________________ CEEB/ACT Code _____________________________________

IMPORTANT PRIVACY NOTICE: Under the terms of the Family Educational Rights and Privacy Act (FERPA), after you matriculate you will have access to this form
and all other recommendations and supporting documents submitted by you and on your behalf, unless at least one of the following is true:
1. The institution does not save recommendations post-matriculation (see list at www.commonapp.org/FERPA).
2. You waive your right to access below, regardless of the institution to which it is sent:

Yes, I do waive my right to access, and I understand I will never see this form or any other recommendations submitted by me or on my behalf.

No, I do not waive my right to access, and I may someday choose to see this form or any other recommendations or supporting documents submitted by me
or on my behalf to the institution at which I'm enrolling, if that institution saves them after I matriculate.
Required Signature _______________________________________________________________________________________ Date _________________

TO THE TEACHER
The Common Application membership nds candid evaluations helpful in choosing from among highly qualied candidates. You are encouraged to keep this form
in your private les for use should the student need additional recommendations. Please submit your references promptly, and remember to sign below.
Teachers Name (Mr./Ms./Dr., etc.) ________________________________________________ Subject Taught _______________________________________
Please print or type

Signature _________________________________________________________________________________________________ Date _____________________

mm/dd/yyyy

Secondary School _______________________________________________________________________________________________________________

School Address ________________________________________________________________________________________________________________
Number & Street

City/Town

State/Province

Country

ZIP/Postal Code

Teachers Telephone (_______) __________________________________________________ Teachers E-mail _____________________________________

Area/Country/City Code

Number

Ext.

Background Information
How long have you known this student and in what context? _______________________________________________________________________________
What are the rst words that come to your mind to describe this student? _____________________________________________________________________
List the courses you have taught this student, noting for each the students year in school (10th, 11th, 12th; rst-year, sophomore; etc.) and the level of course difculty
(AP, IB, accelerated, honors, elective; 100-level, 200-level; etc.).
_______________________________________________________________________________________________________________________________

2010 The Common Application, Inc.

TEACHER EVALUATION 1

TE-1 / 2010-11

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

No basis

Below average

Average

Good
(above average)

Very good
(well above
average)

Excellent
(top 10%)

One of the top few

Outstanding Ive encountered
(top 5%)
(top 1%)

Academic achievement
Intellectual promise
Quality of writing
Creative, original thought
Productive class discussion
Respect accorded by faculty
Disciplined work habits
Maturity
Motivation
Leadership
Integrity
Reaction to setbacks
Concern for others
Self-condence
Initiative, independence
OVERALL

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.)

2010 The Common Application, Inc.

TEACHER EVALUATION 1

TE-2 / 2010-11

TE

2010-11 Teacher Evaluation

For Spring 2011 or Fall 2011 Enrollment

TO THE APPLIC ANT

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.

Female
Legal Name ___________________________________________________________________________________________________________________

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

First/Given

Middle (complete)

Jr., etc.

Birth Date __________________________________________________________________ Social Security # _____________________________________

mm/dd/yyyy

(Optional)

Address ________________________________________________________________________________________________________________________
Number & Street

Apartment #

City/Town

State/Province

Country

ZIP/Postal Code

School you now attend ________________________________________________________ CEEB/ACT Code _____________________________________

IMPORTANT PRIVACY NOTICE: Under the terms of the Family Educational Rights and Privacy Act (FERPA), after you matriculate you will have access to this form
and all other recommendations and supporting documents submitted by you and on your behalf, unless at least one of the following is true:
1. The institution does not save recommendations post-matriculation (see list at www.commonapp.org/FERPA).
2. You waive your right to access below, regardless of the institution to which it is sent:

Yes, I do waive my right to access, and I understand I will never see this form or any other recommendations submitted by me or on my behalf.

No, I do not waive my right to access, and I may someday choose to see this form or any other recommendations or supporting documents submitted by me
or on my behalf to the institution at which Im enrolling, if that institution saves them after I matriculate.
Required Signature _______________________________________________________________________________________ Date _________________

TO THE TEACHER
The Common Application membership nds candid evaluations helpful in choosing from among highly qualied candidates. You are encouraged to keep this form
in your private les for use should the student need additional recommendations. Please submit your references promptly, and remember to sign below.
Teachers Name (Mr./Ms./Dr., etc.) ________________________________________________ Subject Taught _______________________________________
Please print or type

Signature _________________________________________________________________________________________________ Date _____________________

mm/dd/yyyy

Secondary School _______________________________________________________________________________________________________________

School Address ________________________________________________________________________________________________________________
Number & Street

City/Town

State/Province

Country

ZIP/Postal Code

Teachers Telephone (_______) __________________________________________________ Teachers E-mail _____________________________________

Area/Country/City Code

Number

Ext.

Background Information
How long have you known this student and in what context? _______________________________________________________________________________
What are the rst words that come to your mind to describe this student? _____________________________________________________________________
List the courses you have taught this student, noting for each the students year in school (10th, 11th, 12th; rst-year, sophomore; etc.) and the level of course difculty
(AP, IB, accelerated, honors, elective; 100-level, 200-level; etc.).
_______________________________________________________________________________________________________________________________

2010 The Common Application, Inc.

TEACHER EVALUATION 2

TE-1/ 2010-11

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

No basis

Below average

Average

Good
(above average)

Very good
(well above
average)

Excellent
(top 10%)

One of the top few

Outstanding Ive encountered
(top 5%)
(top 1%)

Academic achievement
Intellectual promise
Quality of writing
Creative, original thought
Productive class discussion
Respect accorded by faculty
Disciplined work habits
Maturity
Motivation
Leadership
Integrity
Reaction to setbacks
Concern for others
Self-condence
Initiative, independence
OVERALL

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.)

2010 The Common Application, Inc.

TEACHER EVALUATION 2

TE-2/ 2010-11

2010-11 SECONDARY school report

SR

For Spring 2011 or Fall 2011 Enrollment

TO THE APPLIC ANT

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

Female
Legal Name ___________________________________________________________________________________________________________________

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

First/Given

Middle (complete)

Jr., etc.

Birth Date __________________________________________________________________ Social Security # _____________________________________

mm/dd/yyyy

(Optional)

Address ________________________________________________________________________________________________________________________
Number & Street

Apartment #

City/Town

State/Province

Country

ZIP/Postal Code

School you now attend ________________________________________________________ CEEB/ACT Code _____________________________________

Current year coursesplease 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.
First Semester/Trimester

Second Semester/Trimester

Third Trimester
or additional rst/second term courses if more space is needed

________________________________________

________________________________________

_________________________________________

________________________________________

________________________________________

_________________________________________

________________________________________

________________________________________

_________________________________________

________________________________________

________________________________________

_________________________________________

________________________________________

________________________________________

_________________________________________

________________________________________

________________________________________

_________________________________________

________________________________________

________________________________________

_________________________________________

________________________________________

________________________________________

_________________________________________

IMPORTANT PRIVACY NOTE: By signing this form, I authorize all schools that I have attended to release all requested records covered under the Family
Federal
Educational Rights and Privacy Act (FERPA) so that my application may be reviewed by the Common Application member institution(s) to which I am applying.
I further authorize the admission ofcers reviewing my application, including seasonal staff employed for the sole purpose of evaluating applications, to contact
ofcials at my current and former schools should they have questions about the school forms submitted on my behalf.
I understand that under the terms of the FERPA, after I matriculate I will have access to this form and all other recommendations and supporting documents
submitted by me and on my behalf, unless at least one of the following is true:
1. The institution does not save recommendations post-matriculation (see list at www.commonapp.org/FERPA).
2. I waive my right to access below, regardless of the institution to which it is sent:

Yes, I do waive my right to access, and I understand I will never see this form or any other recommendations submitted by me or on my behalf.

No, I do not waive my right to access, and I may someday choose to see this form or any other recommendations or supporting documents submitted by me or
on my behalf to the institution at which Im enrolling, if that institution saves them after I matriculate.
Required Signature _______________________________________________________________________________________ Date _________________

TO THE SECONDARY SCHOOL COUNSELOR

Attach applicants ofcial transcript, including courses in progress, a school prole, and transcript legend. (Check transcript copies for readability.) Use both pages to
complete your evaluation for this student. Be sure to sign below.
Counselors Name (Mr./Ms./Dr., etc.) ________________________________________________________________________________________________
Please print or type

Signature _________________________________________________________________________________________________ Date _____________________

mm/dd/yyyy

Title ___________________________________________________________ School _______________________________________________________

School Address _________________________________________________________________________________________________________________
City/Town

State/Province

Country

ZIP/Postal Code

Counselors Telephone (_______) ____________________________________

____ Counselors Fax (_______) _________________________________
________
Area/Country/City Code

Number

Ext.

Area/Country/City Code

Number

Secondary school CEEB/ACT code ___________________________ Counselors E-mail _________________________________________________________

2010 The Common Application, Inc.

SR-1 / 2010-11

Background Information

Class Rank ___________ Class Size ___________ Covering a period from __________ to __________.
(mm/yyyy)

(mm/yyyy)

The rank is
weighted
unweighted. How many 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)

(mm/yyyy)

This GPA is
weighted
unweighted. The schools passing mark is ________________________________.

Highest GPA in class ____________________________________ Graduation Date ___________________
(mm/dd/yyyy)

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

How many courses does your school offer:

AP _________ IB _________ Honors _________
If school policy limits the number a student may take,
please list the maximum allowed:
AP _________ IB _________ Honors _________
Is the applicant an IB Diploma candidate?
Yes
No
Are classes taken on a block schedule?
Yes
No
In comparison with other college preparatory students
at your school, the applicants course selection is:

most demanding

very demanding

demanding

average

below average

How long have you known this student and in what context? _________________________________________________________________________________
What are the rst words that come to your mind to describe this student? ______________________________________________________________________

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

No basis

Below average

Average

Good (above
average)

Very good
(well above
average)

Excellent
(top 10%)

Outstanding
(top 5%)

One of the top few

Ive encountered
(top 1%)

Academic achievement
Extracurricular accomplishments
Personal qualities and character
OVERALL

Evaluation Please provide comments that will help us differentiate this student from others. Feel free to attach an additional sheet or another reference youve prepared for this
student. We especially welcome a broad-based assessment and encourage you to consider describing or addressing:
The applicants academic, extracurricular, and personal characteristics.
Relevant context for the applicants 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.

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

academic misconduct or behavioral misconduct, that resulted in the applicants probation, suspension, removal, dismissal, or expulsion from your institution?
Yes
No

Yes
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 to be kept condential by a court.]

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

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.

Check here if you would prefer to discuss this applicant over the phone with each admission office.
I recommend this student:
No basis
With reservation
Fairly strongly
Strongly
Enthusiastically

2010 The Common Application, Inc.

SR-2 / 2010-11

MR

2010-11 MIDYEAR Report

For Spring 2011 or Fall 2011 Enrollment

TO THE APPLIC ANT

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

Female
Legal Name ___________________________________________________________________________________________________________________

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

First/Given

Middle (complete)

Jr., etc.

Birth Date __________________________________________________________________ Social Security # _____________________________________

mm/dd/yyyy

(Optional)

Address ________________________________________________________________________________________________________________________
Number & Street

Apartment #

City/Town

State/Province

Country

ZIP/Postal Code

School you now attend ________________________________________________________ CEEB/ACT Code _____________________________________

Current year coursesplease 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.
First Semester/Trimester

Second Semester/Trimester

Third Trimester
or additional rst/second term courses if more space is needed

________________________________________

________________________________________

_________________________________________

________________________________________

________________________________________

_________________________________________

________________________________________

________________________________________

_________________________________________

________________________________________

________________________________________

_________________________________________

________________________________________

________________________________________

_________________________________________

________________________________________

________________________________________

_________________________________________

________________________________________

________________________________________

_________________________________________

________________________________________

________________________________________

_________________________________________

IMPORTANT PRIVACY NOTE: By signing this form, I authorize all schools that I have attended to release all requested records covered under the Family
Federal
Educational Rights and Privacy Act (FERPA) so that my application may be reviewed by the Common Application member institution(s) to which I am applying.
I further authorize the admission ofcers reviewing my application, including seasonal staff employed for the sole purpose of evaluating applications, to contact
ofcials at my current and former schools should they have questions about the school forms submitted on my behalf.
I understand that under the terms of the FERPA, after I matriculate I will have access to this form and all other recommendations and supporting documents
submitted by me and on my behalf, unless at least one of the following is true:
1. The institution does not save recommendations post-matriculation (see list at www.commonapp.org/FERPA).
2. I waive my right to access below, regardless of the institution to which it is sent:

Yes, I do waive my right to access, and I understand I will never see this form or any other recommendations submitted by me or on my behalf.

No, I do not waive my right to access, and I may someday choose to see this form or any other recommendations or supporting documents submitted by me
or on my behalf to the institution at which Im enrolling, if that institution saves them after I matriculate.
Required Signature _______________________________________________________________________________________ Date _________________

TO THE SECONDARY SCHOOL COUNSELOR

Please submit this form when midyear grades are available (end of rst semester or second trimester). Attach applicants ofcial transcript, including courses
in progress, a school prole, and transcript legend. (Please check transcript copies for readability.) Use both pages to complete your evaluation for this student.
Be sure to sign below.
Counselors Name (Mr./Ms./Dr., etc.) ________________________________________________________________________________________________
Please print or type

Signature _________________________________________________________________________________________________ Date _____________________

mm/dd/yyyy

Title ___________________________________________________________ School ________________________________________________________

School Address _________________________________________________________________________________________________________________
City/Town

State/Province

Country

ZIP/Postal Code

Counselors Telephone (_______) ____________________________________

____ Counselors Fax (_______) _________________________________
________
Area/Country/City Code

Number

Ext.

Area/Country/City Code

Number

Secondary school CEEB/ACT code ___________________________ Counselors E-mail _________________________________________________________

2010 The Common Application, Inc.

MR-1 / 2010-11

Background Information If any of the information on this page has changed for this student since the Secondary School Report was submitted, please enter the
new information in the appropriate section below. If your recommendation for this student has changed, please comment in the space below or on a separate sheet.
If nothing has changed, you may leave this page blank. However, your signature is still required.

Class Rank ___________ Class Size ___________ Covering a period from __________ to __________.
(mm/yyyy)

(mm/yyyy)

The rank is
weighted
unweighted. How many 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)

(mm/yyyy)

This GPA is
weighted
unweighted. The schools passing mark is ________________________________.

Highest GPA in class ____________________________________ Graduation Date ___________________
(mm/dd/yyyy)

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

How many courses does your school offer:

AP _________ IB _________ Honors _________
If school policy limits the number a student may take,
please list the maximum allowed:
AP _________ IB _________ Honors _________
Is the applicant an IB Diploma candidate?
Yes
No
Are classes taken on a block schedule?
Yes
No
In comparison with other college preparatory students
at your school, the applicants course selection is:

most demanding

very demanding

demanding

average

below average

How long have you known this student and in what context? _________________________________________________________________________________
What are the rst words that come to your mind to describe this student? ______________________________________________________________________

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

No basis

Below average

Average

Good (above
average)

Very good
(well above
average)

Excellent
(top 10%)

Outstanding
(top 5%)

One of the top few

Ive encountered
(top 1%)

Academic achievement
Extracurricular accomplishments
Personal qualities and character
OVERALL

Evaluation Please use this space to elaborate on any changes in the students academic record, personal demeanor, or status at your school.

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

academic misconduct or behavioral misconduct, that resulted in the applicants probation, suspension, removal, dismissal, or expulsion from your institution?
Yes
No

Yes
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 to be kept condential by a court.]

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

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.

Check here if you would prefer to discuss this applicant over the phone with each admission office.
I recommend this student:
No basis
With reservation
Fairly strongly
Strongly
Enthusiastically

2010 The Common Application, Inc.

MR-2 / 2010-11

FR

2010-11 nal Report

For Spring 2011 or Fall 2011 Enrollment

TO THE APPLIC ANT

After completing all the relevant questions below, give this form to your secondary school counselor or another school ofcial who knows you better. If applying via
mail, please also give that school ofcial a stamped envelope addressed to the institution you plan to attend.

Female
Legal Name ___________________________________________________________________________________________________________________

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

First/Given

Middle (complete)

Jr., etc.

Birth Date __________________________________________________________________ Social Security # _____________________________________

mm/dd/yyyy

(Optional)

Address ________________________________________________________________________________________________________________________
Number & Street

Apartment #

City/Town

State/Province

Country

ZIP/Postal Code

School you now attend ________________________________________________________ CEEB/ACT Code _____________________________________

Current year coursesplease 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.
First Semester/Trimester

Second Semester/Trimester

Third Trimester
or additional rst/second term courses if more space is needed

________________________________________

________________________________________

_________________________________________

________________________________________

________________________________________

_________________________________________

________________________________________

________________________________________

_________________________________________

________________________________________

________________________________________

_________________________________________

________________________________________

________________________________________

_________________________________________

________________________________________

________________________________________

_________________________________________

________________________________________

________________________________________

_________________________________________

________________________________________

________________________________________

_________________________________________

IMPORTANT PRIVACY NOTE: By signing this form, I authorize all schools that I have attended to release all requested records covered under the Family
Federal
Educational Rights and Privacy Act (FERPA) so that my application may be reviewed by the Common Application member institution(s) to which I am applying.
I further authorize the admission ofcers reviewing my application, including seasonal staff employed for the sole purpose of evaluating applications, to contact
ofcials at my current and former schools should they have questions about the school forms submitted on my behalf.
I understand that under the terms of the FERPA, after I matriculate I will have access to this form and all other recommendations and supporting documents
submitted by me and on my behalf, unless at least one of the following is true:
1. The institution does not save recommendations post-matriculation (see list at www.commonapp.org/FERPA).
2. I waive my right to access below, regardless of the institution to which it is sent:

Yes, I do waive my right to access, and I understand I will never see this form or any other recommendations submitted by me or on my behalf.

No, I do not waive my right to access, and I may someday choose to see this form or any other recommendations or supporting documents submitted by me
or on my behalf to the institution at which Im enrolling, if that institution saves them after I matriculate.
Required Signature _______________________________________________________________________________________ Date _________________

TO THE SECONDARY SCHOOL COUNSELOR

Please submit this form when nal grades are available (end of second semester or third trimester). Attach applicants ofcial transcript, a school prole, and transcript
legend. (Please check transcript copies for readability.) Use both pages to complete your evaluation for this student. Be sure to sign below.
Counselors Name (Mr./Ms./Dr., etc.) ________________________________________________________________________________________________
Please print or type

Signature _________________________________________________________________________________________________ Date _____________________

mm/dd/yyyy

Title ___________________________________________________________ School ________________________________________________________

School Address _________________________________________________________________________________________________________________
City/Town

State/Province

Country

ZIP/Postal Code

Counselors Telephone (_______) ____________________________________

____ Counselors Fax (_______) _________________________________
________
Area/Country/City Code

Number

Ext.

Area/Country/City Code

Number

Secondary school CEEB/ACT code ___________________________ Counselors E-mail __________________________________________________________

2010 The Common Application, Inc.

FR-1/ 2010-11

Background Information If any of the information on this page has changed for this student since the Midyear Report was submitted, please enter the new
information in the appropriate section below. If your recommendation for this student has changed, please comment in the space below or on a separate sheet.
If nothing has changed, you may leave this page blank. However, your signature is still required.

Class Rank ___________ Class Size ___________ Covering a period from __________ to __________.
(mm/yyyy)

(mm/yyyy)

The rank is
weighted
unweighted. How many 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)

(mm/yyyy)

This GPA is
weighted
unweighted. The schools passing mark is ________________________________.

Highest GPA in class ____________________________________ Graduation Date ___________________
(mm/dd/yyyy)

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

How many courses does your school offer:

AP _________ IB _________ Honors _________
If school policy limits the number a student may take,
please list the maximum allowed:
AP _________ IB _________ Honors _________
Is the applicant an IB Diploma candidate?
Yes
No
Are classes taken on a block schedule?
Yes
No
In comparison with other college preparatory students
at your school, the applicants course selection is:

most demanding

very demanding

demanding

average

below average

How long have you known this student and in what context? _________________________________________________________________________________
What are the rst words that come to your mind to describe this student? ______________________________________________________________________

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

No basis

Below average

Average

Good (above
average)

Very good
(well above
average)

Excellent
(top 10%)

Outstanding
(top 5%)

One of the top few

Ive encountered
(top 1%)

Academic achievement
Extracurricular accomplishments
Personal qualities and character
OVERALL

Evaluation Please use this space to elaborate on any changes in the students academic record, personal demeanor, or status at your school.

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

academic misconduct or behavioral misconduct, that resulted in the applicants probation, suspension, removal, dismissal, or expulsion from your institution?
Yes
No

Yes
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 to be kept condential by a court.]

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

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.

Check here if you would prefer to discuss this applicant over the phone with each admission office.
I recommend this student:
No basis
With reservation
Fairly strongly
Strongly
Enthusiastically

2010 The Common Application, Inc.

FR-2/ 2010-11