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011-12 First-year ApplicationFor Spring 2012 or Fall 2012 Enrollment
AP-1/201 2011 The Common Application, Inc.
APPLICANT
Legal Name ________________________________________________________________________________________________________________Last/Family/Sur (Enter nameexactlyas 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 FA
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 ZIP/Postal C
If different from above, please give your current mailing address for all admission corresponden _____ to _________(mm/dd/yyyy) (mm/dd/yyyy
Current mailing address _____________________________________________________ _____________________Number & Street Apartment #
__________________________________________________________________ __________________________City/Town County or Parish State/Province Country ZIP/Postal C
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 on me of the questions you see in this section, this collechose not to ask that question of its applicants.
College __________________________________________ _______________________________________________mm/dd/yyyy
Entry Term: Fall (Jul-Dec) pring (Jan-Ju
Decision Plan____________________________
Academic Interests ___________________
_______________________________
___________________________ ___
Career Interest_____________ _______
end to apply for need-based financial aid? Yes N
u intend to apply for merit-based scholarships? Yes N
o you intend to be a full-time student? Yes N
Do you intend to enroll in a degree program your first year? Yes N
Do you intend to live in college housing? ___________________________
hat is the highest degree you intend to earn? _______________________
DEMOGRAPHICS
Female Male
Citizenship Status _________________
Non-US Citizen _____________________
_____________ ________________________
________________ ____________________________
Birthplace ____________ _________________________________City/Town State/Province Country
Years lived in the US? ____________
S(Speak) R(Read) W(Write) F(First Language) H(Spoken at Home)
Optional The items with a gray background are optional. No information youThe items with a gray background are optional. No information youprovide will be used in a discriminatory manner.provide will be used in a discriminatory manner.
Religious PreferenceReligious Preference ______________________________________________________________________________________________
1.1. Are you Hispanic/Latino?Are you Hispanic/Latino?
Yes, Hispanic or Latino (including Spain)Yes, Hispanic or Latino (including Spain) NoNo If yes, please describe your backgrouIf yes, please describe your backgrou
____________________________________________________________________________________________________________________
2.2. Regardless of your answer to the prior question,Regardless of your answer to the prior question, please indicate how you identplease indicate how you identourself. ( and describe your background.)ourself. ( and describe your background.)
American Indian or Alaska NaAmerican Indian or Alaska Native (including all Original Peoples of the Americas)tive (including all Original Peoples of the Americas)
Are you Enrolled?Are you Enrolled? YesYes No If yes, please enter Tribal Enrollment Number_____________No If yes, please enter Tribal Enrollment Number_____________
____________________________________________________________________________________________________________________
Asian (including Indian subcontinent and Philippines)Asian (including Indian subcontinent and Philippines)
____________________________________________________________________________________________________________________
Black or African American (including Africa and Caribbean)Black or African American (including Africa and Caribbean)
____________________________________________________________________________________________________________________
Native Hawaiian or Other Pacific Islander (Original Peoples)Native Hawaiian or Other Pacific Islander (Original Peoples)
____________________________________________________________________________________________________________________
White (including Middle Eastern)White (including Middle Eastern)
____________________________________________________________________________________________________________________
__________ode
________________________ __
_____________________________ ____ _ Apartment #ent #
_________________________________ __ ___tate/Provinceovince CountryCo
e. (from _____e. _mm
_______________________________ ___Ap
_____________________________ ___ __ __tate/Province
_____________________________ ___ ____ ___
URE PLANSPP
ne system did not ask you to answer st a er s
_________________ __ Deadline ___lin
))
_________________________ ___
____________________________ ___
__________________________________ ___ __
_______________________________ __ ___ ___
______________________________ __ _
Do you iu i
Do y
______________________________ __ ___
ipip ___________________________ ___
_________________________ ___
____________________
____________
equired for US Cit izens and Permanent Residen a plying for f inancial aid via FA
Years lived outside the US? ____________
Language Proficiency (Check all that apply.)(Speak) R(Read) W(Write) F(First Language) H(Spoken at Home)
S R F H
_______________________________________________
_______________________________________________
_______________________________________________
Check one or moreCheck one or more
US Armed SerUS Armed Services veteran statusvices veteran status __________________________________________________________________________
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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 demographpurposes 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 informatiobelow 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.
HouseholdParents marital status (relative to each other): Never Married Married Widowed Separated Divorced (date _______
mm/yyyWith whom do you make your permanent home? Parent 1 Parent 2 Both Legal Guardian Ward of the Court/State Other
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 yo
_____________________ __________
_________________ ______________
Preferred Telephon ________________Area/Country/City Code
E-mail ______ _______________________
Occupation _______ ____________________________
Employer _____________ ________________________________
College (if any) ___________________________________ CEEB ________
Degree _________________________________________ Year _________
Graduate School (if any) ____________________________ CEEB________
Degree _________________________________________ Year _________
Siblingsse give names and ages of your brothers or sisters. If they are enrolled in
rades K-12 (or international equivalent), list their grade levels. If they have
attended or are currently attending college, give the names of the undergraduainstitution, degree earned, and approximate dates of attendance. If more thanthree siblings, please list them in the Additional Information section.
__________________________________________________________Name Age & Grade Relationship
College Attended ___________________________________ CEEB ____
Degree earned _________________________ Dates _______________r expected mm/yyyy mm/yyyy
__________________________________________________________Name Age & Grade Relationship
College Attended ___________________________________ CEEB ____
Degree earned _________________________ Dates _______________r expected mm/yyyy mm/yyyy
__________________________________________________________Name Age & Grade Relationship
College Attended ___________________________________ CEEB ____
Degree earned _________________________ Dates _______________r expected mm/yyyy mm/yyyy
Parent 1: Mother Father Unknown
Is Parent 1 living? Yes 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: Home Cell Work (_______) ________________Area/Country/City Code
E-mail _______________________________________________________
Occupation _____________________________________________________
Employer _____________________________________________________
College (if any) ___________________________________ CEEB______
Degree _________________________________________ Ye r ___
Graduate School (if any) ____________________________ CE
Degree _______________________________________
Parent 2: Mother Father Unknown
Is Parent 2 living? Yes No (Date Deceased __________________
mm/yyyy
Last/Family /Sur First/Given Middle Title (Mr./Mrs./Ms.
Country of birth ________________ ____________
Home address if different from yo
_____________________ ________
_________________ ____________
Preferred Telephon ______________Area/Country/City Code
E-mail ___ ____________________
Occup _________________________
_____________________________
_______________________ CEEB_____
___________________________ Year ______
y) ____________________________ CEEB_____
____________________________________ Year ______
Spouse/Child
mm/yyyy mm/y
_
______
___________
__ YeYe r __________
MiddM
_________________ __
rsrs
______________________________ ____ __
_________________________________ __ ___
:: Home CellCell Work (______rkArea/CoA
______________________________ __ __
tion ___________________________ ___
mployer _____________________plo ___ ___
College (if any)if a _________________
DegreeDe ________________
Graduate School (if aad
Degreeee ____
___________________________ ___
________________________________ _Middle Title (Mr./Mrs./Ms./Dr.)Ti tl . /Dr. )
_______________________________ __ ___ ___
rsrs
_______________________________ ________________
__________________________________ ___
:: Home CellCe Work (______rk (_Area/CoArea
___________________________ ___
____________________
__________
iblinPle
Civil Union/Domestic Partners
Spouse/ChildSpouse/Child College Attended __________________________________ CEEB______
Marital Status _____________________ Degree Earned/Expected _______________________ Dates ___________mm/yyyy mm/y
pouses Name __________________________________________________ If you have children, how many? _________
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EDUCATIONSecondary SchoolsMost recent secondary school attended ___________________________________________________________________________________________
Entry Date _________________ Graduation Date _________________ School Type: Public Charter Independent Religious Home Schmm/yyyy mm/dd/yyyy
Address ________________________________________________________________________________ CEEB/ACT Code ________________________Number & Street
_______________________________________________________________________________________________________________________________City/Town State/Province Country ZIP/Postal C
Counselors Name __________________________________________________________Counselors Title ____________________________________
E-mail _____________________________________ Telephone (_______) ______________________ Fax (_______) _____ __________________ Area/Country/Ci ty Code Number Ext. Area/Count ry/City Code Number
List all other secondary schools you have attended since 9th grade, including summer schools or enrichment programs hosted ool campus:
School Name & CEEB/ACT Code Location (City, State/Province, ZIP/Postal Code, Country) Dates Attended (mm/yy
_____________________________________________ _______________________________________ _______
_____________________________________________ ___________________________________ _________
_____________________________________________ ________________________________ ____________
Please list any community program/organization that has provided free assistance with your application pr ________________
If your education was or will be interrupted, please indicate so here and provide details in the Additio ____________________
Colleges & Universities
College/University Name & CEEB/ACT Code Location (City, State/Province, ZIP/Postal Code, Country) Degree Candidate? CO EP Dates Attended Degree Ea
Yes No mm/yyyy mm/yyyy
_________________________________ ________________________ ______________ _______
_________________________________ _____________________ ______________ _______
_________________________________ __________________ ______________ _______
ACADEMICS
The self-reported information in this section is not intend rds. Please note the requirements of each institution to which you arpplying and arrange for official transcripts and score school and the appropriate testing agencies. Where Best Scores are
requested, please report the highest individual scor scores are from different test dates.
Grades Class Rank _________ Class Si No GPA _________ Scale _________ Weighted? Yes if available) if available)
ACT Exam Dates: ________ Scores: _________ ______ _________ ______ _________ ____past & future) mm/yyyy far) OMP mm/yyyy nglish m/yyyy Math mm/y
_________ ______ _________ ______ _________ ____Reading mm/yyyy cience m/yyyy riting mm/y
SAT Exam Dates: __ Best Scores: _________ ______ _________ ______ _________ ____past & future) so far) ritical Reading mm/yyyy Math mm/yyyy Writing mm/y
TOEFL/ Exam Date _ Best Score: _________ ______ ______IELTS past & future so far) Test core mm/yyyy
AP/IB/SATSubjects
Best ______________________ _____ ________ __________________________________ __per Type & Subject core mm/yyyy Type & Subject c
__________________________ _____ ________ __________________________________ ___Type & Subject core mm/yyyy Type & Subject c
______________________________ _____ ________ __________________________________ ___Type & Subject core mm/yyyy Type & Subject c
__ __________________________________ _____ ________ __________________________________ ___m Type & Subject core mm/yyyy Type & Subject c
Current Courses Please indi te title, level (AP, IB, advanced honors, etc.) and credit value of all courses you are taking this year. Indicate quarter classes taken the same semester on the appropriate semester line.
Full Year/First Semester/First Trimester Second Semester/Trimester Third Trimesteror additional first/second term courses if more space is need
________________________________________ ________________________________________ ______________________________________
________________________________________ ________________________________________ ______________________________________
________________________________________ ________________________________________ ______________________________________
________________________________________ ________________________________________ ______________________________________
________________________________________ ________________________________________ ______________________________________
________________________________________ ________________________________________ ______________________________________
________________________________________ ________________________________________ ______________________________________
________________________________________ ________________________________________ ______________________________________
_______ode
n a secondary scar
untry)untruntr Dates ADD
__________________ ____ ___________
_____________________ _____________
___________________________ __ ____
cess:ces ____________________________ __
l Information section:l In ______________
ountry)oo Degree Candidate?egregr
Yes No
____________________ ____
_______________________ ___
___________________________ __
ACADEEEMICS
d to take the place of your official recd to receports to be sent from your secondaryepo fro
s you have earned so far, even if thoss yo ed s
e _________ Weighted?___ We Yess
_______ ___________ _ _ BesBesmm/yyyym m/yyyy s s
_____ ________ __________ __ ________m/yyyy mm/yyyy yyy m/yyyyy
: ________ ________ ____________ ___)) m/yyyy/yyyy mm/yyyym/yyy mm/yyyy
cores:cor __________ _______________subject, so far)subjec mm/yyyyy
___________ ________mm/yyyymm/yy
__________ ___mm/yyyy
_________ /yyyy/yyyy
Colleges & UniversitiesColleges & Universities Report all college attendance (including online) since 9th grade and ment Program (EP) hosted on ndicate as College Course (CO) or Enrindic e C
ollege campus.PPOOOO
Were you issued a transcript for any work listed above? Yes No t sent as soon as possible.If yes, please have an official transcrie a ri
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Common Application member institution admission offices do not discriminate on the basis of race, color, ethnicity, national origin, religion, creed, seCommon Application member institution admission offices do not discriminate on the basis of race, color, ethnicity, national origin, religion, creed, sege, marital status, parental status, physical d isability, learning disability, political affiliation, veteran status, or sexual orientation.ge, marital status, parental status, physical d isability, learning disability, political affiliation, veteran status, or sexual orientation.
WRITING
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
___________________________________________________________________________________________________ ____________________
______________________________________________________________________________________________ _______________
Please write an essay of on a topic of your choice or on one of the options listed below, and attach it to mission. Plea
indicate your topic by checking the appropriate box. his personal essay helps us become acquainted with you a courses,
rades, test scores, and other objective data. It will also demonstrate your ability to organize your thoughts and ex plication
essay should be the same for all colleges. Do not customize it in any way for individual colleges. Colleges that ask for them
supplement form.
Evaluate a significant experience, achievement, risk you have taken, or ethical dilemma you
Discuss some issue of personal, local, national, or international concern and its importan
Indicate a person who has had a significant influence on you, and describe that influe
Describe a character in fiction, a historical figure, or a creative work (as in art, musi e on you, and explain that influen
A range of academic interests, personal perspectives, and life experiences ad our personal background, describexperience that illustrates what you would bring to the diversity in a college trated the importance of diversity to you
Topic of your choice.
Additional Information Please attach a separate sheet if you wish to pr ations not reflected in the application.
Disciplinary History Have you ever been found responsible for a disciplinary violatio attended from the 9th grade (or the international equivale
forward, whether related to academic misconduct or behavio linary action?robation, suspension, removal, dismissal, or expulsio
Have you ever been adjudicated guilty or convicted of Yes No[Note that you are not required to answer yes to , if the criminal adjudication or conviction has been expunged, sealed,nnulled, pardoned, destroyed, erased, impoun e kept confidential.]
If you answered yes to either or both questions that gives the approximate date of each incident, explains the circumstances, a
reflects on what you learned from the experie
SIGNATURE
Application Fee Payment lication fee, how will you be paying it?lication fee, how will you be paying it?
Online PaymOnline Paym ee Waiver Requestee Waiver Request Will Mail Fee Waiver RequestWill Mail Fee Waiver Request
Required Signature
I certify that a the admission processincluding the application, the personal essay, any supplements, and any other supportingI certify that a the admission processincluding the application, the personal essay, any supplements, and any other supportingmaterialsis m true, and honestly presented, and that these documents will become the property of the institutions to which I am applyingmaterialsis m true, and honestly presented, and that these documents will become the property of the institutions to which I am applying
and will not be retu derstand that I may be subject to a range of possible disciplinary actions, including admission revocation, expulsion, orand will not be retu derstand that I may be subject to a range of possible disciplinary actions, including admission revocation, expulsion, orrevocation of course cr des, and degree, should the information I have certified be false.revocation of course cr des, and degree, should the information I have certified 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 conditionaI acknowledge that I have reviewed the application instructions for each college receiving this application. I understand that all offers of admission are conditionapending receipt of final transcripts showing work comparable in quality to that upon which the offer was based, as well as honorable dismissal from the school.pending receipt of final transcripts showing work comparable in quality to that upon which the offer was based, as well as honorable dismissal from the school.
I affirm that I will send an enrollment deposit (or equivalent) to only one institution; sending multiple deposits (or equivalent) may result in the withdrawal of myI affirm that I will send an enrollment deposit (or equivalent) to only one institution; sending multiple deposits (or equivalent) may result in the withdrawal of myadmission offers from all institutions. [Note: students may send an enrollment deposit (or equivalent) to a second institution where they have been admitted fromadmission offers from all institutions. [Note: students may send an enrollment deposit (or equivalent) to a second institution where they have been admitted fromthe waitlist, provided that they inform the first institution that they will no longer be enrolling.]the waitlist, provided that they inform the first institution that they will no longer be enrolling.]
ignature _______________________________________________________________________________________________ Date __________________ignature _______________________________________________________________________________________________ Date __________________mm/dd/yyyy
_
_____________
your application before suyour ef
a person and student, apart frors nd s ap
ress yourself.se NOTE: Your Common A: Yo o
ant customized essay responses willa d nses w
ave faced and its impact on you.ave mpa yo
e to you.e to
ce.ce.
, science, etc.) that has had an influenence, at
s much to the educational mix. Givens he educ venommunity or an encounter that demonun cou on
ide details of circumstances or qualifiils nce
at any educational institution you havat an stital misconduct, that resulted in a disciduct, ed
from the institution.fro . Yes No
misdemeanor, felony, or other crimemi crimeis question, or provide an explanatiois ro
ed, or otherwise ordered by a court toed, o ord
, please attach a separate sheet of papeatta ep
ce..
ymentymentyment If this college requires an apIf this college requires an aplleglleg
ntntntnt Will Mail PaymentWill Mail Paymentil Pil P OnlineOnline
gngngn
l information submitted inl information submitted inl inf mat l inf mat own work, factuallown work, factuallowow
ed to me. I ued to me. I uededdit, grdit, grdit,dit,
Please briefly elaborate on one of your extracurricular activities or work experiences in the space below.
250 500 words
Additional InformationAdditional Information
These actions could include, but are not limiteto:
Note: Applicants are expected to im ich they are applying should there be any changes to he information requestediately notify the institutions to wedia no st o w in this application, including disci linary history.lin y.
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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, ma
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 nameexactlyas 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
chool you now attend ________________________________________________________ CEEB/ACT C _________
TEACHER EVALUATION 1
TO THE TEACHER
The Common Application membership finds candid evaluation y qualified candidates. You are encouraged to keep this formin your private files for use should the student need additio our references promptly, and remember to sign below beformailing directly to the college/university admission
Teachers Name (Mr./Mrs./Ms./Dr.) ___________ ______ Subject Taught ____________________________________Please print or type
ignature _________________________ __________________________________________ Date __________________mm/dd/yyyy
econdary School ___________ ____________________________________________________________________
chool Address _______ __________________________________________________________________________Number & Street City/Town State/Province Country ZIP/Postal Code
Teachers Telepho ________________________________Teachers E-mail __________________________________Area/Country/City Code Number Ext.
Background Information
How long have you known nd in what context? ____________________________________________________________________________
What are the first words that co e to your mind to describe this student? __________________________________________________________________
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 EvaluationFor Spring 2012 or Fall 2012 Enrollment
Fem Ma
T
IMPORTANT PRIIMPORTANT PRIVVACY NOTICE:ACY NOTICE: Under the terms of the Family Educational Rights and Privacy Act (FEUnder the terms of the Family Educational Rights and Privacy Act (FE access to this formaccess to this formnd all other recommendations and supporting documents submitted by you and on your behalf, u :nd all other recommendations and supporting documents submitted by you and on your behalf, u :
1. The institution does not save recommendations post-matriculation1. The institution does not save recommendations post-matriculation (see list at www.common(see list at www.common2. You waive your right to access below, regardless of the institution to which it is sent: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 e or on my behalf. Yes, I do waive my right to access, and I understand I will never see this form or any e or on my behalf.No, I doNo, I do not waivenot waivemy right to access, and I may someday choose to see this form rting documents submitted by memy right to access, and I may someday choose to see this form rting documents submitted by me
or on my behalf to the institution aor on my behalf to the institution at which I'm enrolling, if that institution savest which I'm enrolling, if that institution saves
Required SignatureRequired Signature ______________________________________________________________________________________ ______________ Date _______________________________ Date _________________
___________________________ __ZIP/Postal Co/Po
de __________________________ ______
A), after you matriculate youA), after you matriculate youA), tricu ou A), tricu ouwillwillhavhavess at least one of the following is truess at least one of the following is truess llo g iess llo g i
pp.org/FERPA).pp.org/FERPA).pp. pp.
her recommendations submitted byher recommendations submitted byom atioom atior any other recommendations or suppr any other recommendations or suppr a ecomm uppr a ecomm upp
OOO THE TEACHER
helpful in choosing from among high hoos mal recommendations. Please submital r Plea ub
ffice.ffic
_______________________________ ___Please print or typent or
___________________________________ ____ ___
_______________________________ __ __
_______________________________ ___Number & StreetNum eet
e (_______) _________________e ( __ ___Area/Country/City Code/City
ationatioatio
this studentthis
em after I matriculate.em after I matriculate.afte late.afte late.
_____________________________________________________________ ___ _________ ___ ______
ommon Application offices.Do not mail this form to TheThe
In which grade level(s) was the student enrolled when you taught him/her? 9 10 11 12 Other__________________________________
CAID ________________________________ _________________________
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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 t
few Ive enco
tered
(top 1%)
Intellectual promise
Quality of writingQuality of writing
Creative, original thoughtProductive class discussionProductive class discussion
Respect accorded by faculty
Disciplined work habitsDisciplined work habits
Maturity
MotivationMotivation
Leadership
IntegrityIntegrity
Reaction to setbacks
Concern for othersConcern for others
Self-confidence
Initiative, independenceInitiative, independence
OVERALL
Evaluation Please write whatever you think is important about this student, personal characteristics, as demonstrated inyour classroom. We welcome information that will help us to differentiate th ch an additional sheet or another reference you mhave prepared on behalf of this student.)
TEACHER EVALUATION 2
cluding a description of academic aning tion ic anstudent from others. (Feel free to attfro eel
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Evaluation Please provide comments that will help eel free to attach an additional sheet or another reference you have prepared fthis student. We especially welcome a broad-based assessment
nd encourage you to consider describing or ad
or other circumstances, either posi
Ratings Compared to other students in his or her class year, how do you rate this stude
Has the applicant eve onsible for a disciplinary violation at your school from the 9th grade (or the international equivalent) forward, whether relat
o academic misconduc ral misconduct, that resulted in a disciplinary action? probation, suspensioremoval, dismissal, or expu rom your institution.Yes No
o your knowled e, has the applicant ever been adjudicated guilty or convicted of a misdemeanor, felony, or other crime?Yes NoNote 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,nnulled, pardoned, destroyed, erased, impounded, or otherwise ordered to be kept confidential by a court.]
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 eachincident 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:I recommend this student: No basisNo basis With reservationWith reservation Fairly stronglyFairly strongly StronglyStrongly EnthusiasticallyEnthusiastically
Background Information
No basis
Below
average Average
Good (above
average)
Very good
(well above
average)
Excellent
(top 10%)
Outstanding
(top 5%)
One of the t
few Ive enco
tered
(top 1%)
Extracurricular accomplishmentsExtracurricular accomplishments
Personal qualities and character
OVOVERALLERALL
Ho 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:How many courses does your school offer:AP _________ IB _________ Honors _______AP _________ IB _________ Honors _______
Is the applicant an IB Diploma candidate?Is the applicant an IB Diploma candidate? YesYes
Are classes taken on a block schedule?Are classes taken on a block schedule? YesYes
In comparison with er college preparatory studeIn comparison with er college preparatory studet your school, t nts course selection is:t your school, t nts course selection is:
most demost de very dvery d dede
Class Rank ___________ Class Size ___________ Covering a period from __________ to __________.Class Rank ___________ Class Size ___________ Covering a period from __________ to __________.(mm/yyyy) (mm/yyyy)
The rank isThe rank is weightedweighted unweighted. How many students share this rank? _________________unweighted. How many students share this rank? _________________
How do you report class rank? quartile _____________ quintile _____________ decile ______________How do you report class rank? quartile _____________ quintile _____________ decile ______________
Cumulative GPA: ________ on a _________ scale, covering a period from ____________ to ____________Cumulative GPA: ________ on a _________ scale, covering a period from ____________ to ____________
(mm/yyyy) (mm/yyyy)
This GPA isThis GPA is weightedweighted unweighted. The schools passing mark is ________________________________.unweighted. The schools passing mark is ________________________________.
Highest GPA in class ____________________________________ Graduation Date ___________________Highest GPA in class ____________________________________ Graduation Date ___________________(mm/dd/yyyy)
Percentage of graduating class immediately attending: ___________four-year ________ two-year institutionsPercentage of graduating class immediately attending: ___________four-year ________ two-year institutions
s differentiate this student from others.s di s st
ressing:
ve or negave tive.
in terms of:of:
been found resbee
or behavior bionion
verage
Good (aboveaboabo
average)
VVVery gooderyery
well abovel abovel above
averag
_______________________________ ____ __
_______________________________ _____
tttte applice applicpplppl
andingandingmandingmanding
andingandingandingandingverageveragegege
below averagebelow averageveve
additionaladditional If school policy limits the number a student may takeIf school policy limits the number a student may takegiven year, please list the maximum allowed:given year, please list the maximum allowed:
AP _________ IB _________ Honors _______AP _________ IB _________ Honors _______
Alternatively, you may attach a referen an better describe the student.e written by another school official whoten b er s
These actions could include, but are not limited to: School policy prevents me from responding
School policy prevents me from responding.
Applicants are expected to immediately notify the institutions to which they are applying should there be any changes to the information requested in this applicatioincluding disciplinary history.
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12/13 2011 The Common Application, Inc. MR-1/201
011-12For 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 nameexactlyas 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 C
chool you now attend ________________________________________________________ CEEB/ACT Code ________
Counselors Name (Mr./Mrs./Ms./Dr.) _____________________ ___________________________________________Please print or type
ignature _______________________________________ ____________________________ Date __________________mm/dd/yyyy
Title ____________________________________ _____________________________________ ______________
chool Address _______________________ _________________________________________________________
Number & Street City/Town State/Province Country ZIP/Postal Code
chool Website Address ___________ ______________________________________________________________
Counselor Telephone (_______) ___________ Counselors Fax (_______) ______________________________________ Area/Country/City Code Number Ext. Area/Country/City Code Number
chool CEEB/ACT Code __ ____ Counselors E-mail ______________________________________________________
TO THE SCHOOL COUNSELOR
Please submit this form when midyear grades are available (end of first seme nts official transcript, including coursesin progress and transcript legend. (Please check transcript copies for reada ailing directly to the college/universitydmission office. Do not mail this form to The Common Application
Fem Ma
M
Background Information ow has changed for this student since the School Report was submitted, please enter the new informatiothe appropriate
CClass Rank _______ g a period from _______ to ______.lass Rank _______ g a period from _______ to ______.(mm/yyyy) (mm/yyyy)
The rank isThe rank is weightedweightedHow many additional students rank?__________How many additional students rank?__________
We do not rank. Instead, please indicate quartile ____ quintile ____ decile ______We do not rank. Instead, please indicate quartile ____ quintile ____ decile ______
Cumulative GPA: _____ on a _____ scale, covering a period from _______ to ____Cumulative GPA: _____ on a _____ scale, covering a period from _______ to ____(mm/yyyy) (mm/y
This GPA isThis GPA is weightedweighted unweighted. The schools passing mark is ___________unweighted. The schools passing mark is ___________Highest GPA in class _____________________ Graduation Date _____________Highest GPA in class _____________________ Graduation Date _____________
(mm/dd/yyyy)
If you responded yes to any of the preceding questions, please attach an explanation.
Check here if you would prefer to discuss this applicant over the phone with each admission office.
________________Countryuntr
___________________________ ____ __
__________________________________ __lease print or typeint or ty
________________________________ _____ __
__________________________ __ Schoo
_______________________________ ___
City/Toity/T n
_____________________________________ ___ __
_______________________________ _ ___y/City Codey/Ci umber
_______________________________ __ ___
L COUNSELOOOR
er or second trimester). Attach applicsec ster . plicility.) Be sure to sign below beforeur lo
offices.
rmationrmrm If any of the information bean nforection below.ecti
Class Size ______ CoveriClass Size ______ CoveriCla izeCla ize
unweighted.unweighted.ununshare thishare thisharshar
MIDYEAR Report
IMPORTANT PRIIMPORTANT PRIVVACY NOTE:ACY NOTE: In accordance with the Family Educational Rights and Privacy Act (FERPA), th ur behalfIn accordance with the Family Educational Rights and Privacy Act (FERPA), th ur behalforiginal School Report submitted on yoriginal School Report submitted on yrigin epo on yrigin epo on yreflects your choice to waive or not waive your right of access to all recommendations and supporting d ubsequent reportreflects your choice to waive or not waive your right of access to all recommendations and supporting d ubsequent reportcuments. That response applies to allcuments. That response applies to allc That e ac That e aincluding this one. You chose the following:including this one. You chose the following: Yes, I do waive my right to access, and I understand I will never see this form or any other reco y behalf. Yes, I do waive my right to access, and I understand I will never see this form or any other reco y behalf.mendations submitted by me or onmendations submitted by me or onm me r om me r o No, I do not waive my right to access, and I may someday choose to see this form or any ot uments submitted by me oNo, I do not waive my right to access, and I may someday choose to see this form or any ot uments submitted by me oer recommendations or supporting doer recommendations or supporting doer r o doer r o do
n my behalf to the institution an my behalf to the institution at which I enrolling, if that institution saves them after I mt which I enrolling, if that institution saves them after I m riculate.riculate.ricric
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 applicants disciplinary status at your school since you submitted the original School Report? Yes No School policy prevents me from responding
To your knowled e, have there been any changes to the applicants criminal history since you submitted the original School Report? Yes No School policy prevents me from responding
Do you wish to update your original evaluation of this applicant? Yes No
CAID __________________________________ ________________________
8/3/2019 2012 11CAO Highlighted 1
13/13
2011-12For 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 alsgive that school official stamped envelopes addressed to all institutions requesting a final transcript.
Legal Name __________________________________________________________________________________________________________Last/Family/Sur (Enter nameexactlyas 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 C
chool you now attend ________________________________________________________ CEEB/ACT Code _ ________
Counselors Name (Mr./Mrs./Ms./Dr.) _____________________ ___________________________________________Please print or type
ignature _______________________________________ ____________________________ Date __________________mm/dd/yyyy
Title ____________________________________ _____________________________________ ______________
chool Address _______________________ _________________________________________________________
Number & Street City/Town State/Province Country ZIP/Postal Code
chool Website Address ___________ ______________________________________________________________
Counselor Telephone (_______) ___________ Counselors Fax (_______) ______________________________________ Area/Country/City Code Number Ext. Area/Country/City Code Number
chool CEEB/ACT Code __ __ Counselors E-mail _______________________________________________________
TO THE SCHOOL COUNSELOR
Please submit this form when final grades are available (end of second semes official transcript and transcript legend.(Please check transcript copies for readability.) Be sure to sign below bef versity admission office. Do not mail thisform to The Common Application offices.
Fem Ma
F
Background Information ow has changed for this student since the Midyear Report was submitted, please enter the new informatiin the appropriat
If you responded yes to any of the preceding questions, please attach an explanation.
Ch k h if ld f t di thi li t th h ith h d i i ffi
CClass Rank _______ a period from _______ to ______.lass Rank _______ a period from _______ to ______.(mm/yyyy) (mm/yyyy)
The rank isThe rank is weightedweighted
How many additional student rank?__________How many additional student rank?__________
We do not rank. Instead, please ndicate quartile ____ quintile ____ decile ______We do not rank. Instead, please ndicate quartile ____ quintile ____ decile ______
Cumulative GPA: _____ on a _____ scale, covering a period from _______ to ____Cumulative GPA: _____ on a _____ scale, covering a period from _______ to ____(mm/yyyy) (mm/y
This GPA isThis GPA is
weightedweighted
unweighted. The schools passing mark is ___________unweighted. The schools passing mark is ___________Highest GPA in class _____________________ Graduation Date _____________Highest GPA in class _____________________ Graduation Date _____________
(mm/dd/yyyy)
_______________Countryun t
__________________________ _____ __
__________________________________ __lease print or typerint or
_________________________________ _____ __
__________________________ __ Schoo
_______________________________ ___
City/Toity/T n
_____________________________________ ___ __
______________________________ _ ____y/City Codey/Ci umber
_________________________________ ___ ____
L COUNSELOOOR
er or third trimester). Attach applicantthir r). icante mailing directly to the college/und e c
mationmm If any of the information bef an inforsection below.se
Class Size ______ CoveriClass Size ______ CoveriCl izeCl ize
unweighted.unweighted.unun
share thisshare thissharshar
IMPORTANT PRIIMPORTANT PRIVVACY NOTE:ACY NOTE: In accordance with the Family Educational Rights and Privacy Act (FERPA), th ur behalfIn accordance with the Family Educational Rights and Privacy Act (FERPA), th ur behalforiginal School Report submitted on yoriginal School Report submitted on yrigin epo on yrigin epo on yreflects your choice to waive or not waive your right of access to all recommendations and supporting d ubsequent reportreflects your choice to waive or not waive your right of access to all recommendations and supporting d ubsequent reportcuments. That response applies to allcuments. That response applies to allc That e ac That e aincluding this one. You chose the following:including this one. You chose the following: Yes, I do waive my right to access, and I understand I will never see this form or any other reco y behalf. Yes, I do waive my right to access, and I understand I will never see this form or any other reco y behalf.mendations submitted by me or onmendations submitted by me or onm me r om me r o No, I do not waive my right to access, and I may someday choose to see this form or any ot uments submitted by me oNo, I do not waive my right to access, and I may someday choose to see this form or any ot uments submitted by me oer recommendations or supporting doer recommendations or supporting doer r o doer r o do
n my behalf to the institution an my behalf to the institution at which I enrolling, if that institution saves them after I mt which I enrolling, if that institution saves them after I m riculate.riculate.ricric
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 applicants disciplinary status at your school since you submitted the original School Report? Yes No School policy prevents me from responding
To your knowled e, have there been any changes to the applicants criminal history since you submitted the original School Report? Yes No School policy prevents me from responding
Do you wish to update your original evaluation of this applicant? Yes No
final Report
CAID ___________________________________ _______________________