________________________________Last/Family/Sur (Enter name exactly as it appears on official documents.) First/Given Middle (complete) Jr., etc.Preferred name, if not ?rst name (only one) ____________________________ Birth Date _____________________________________mm/dd/yyyyFormer last name(s) _____________________________________________ US Social Security Number, if any ___________________________________Required for US Citizens and Permanent Residents applying for financial aid via FAFSA nts aFemaleMalePreferred TelephoneHome_____ Cell Home (_______) __________________________________ Cell (_______) __________________________________ __________Area/Country/City Code Area/Country/City CodeE-mail Address ________________________________________________Number & Street_________________ IM Address _____________________________________________ _____________________ _ _______rtment Apartment # ZIP/Postal Code__________________ Permanent home address _________________________________________________________________________________________________ _____________________________ _______ __ ____________________________ ____________________________________________________________________________________________________________________________ _____________________________City/Town County or Parish State/Province Coun CountryIf different from above, please give your current mailing address for all admission correspondence. nce.PR EV IE WNumber & Street County or Parish State/Province Country__ (from ___________ to ___________) ________(m (mm/d (mm/dd/yyyy) (mm/dd/yyyy)Current mailing address __________________________________________________________________________________________________________ ________________________________Apar Apartment # ZIP/Postal Code____________________________________________________________________________________________________________________________ ______________________________City/TownIf your current mailing address is a boarding school, include name of school here: _______________________________ ______________________________________________________________ _ __FUTURE PLANS UTURE PLYour 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 nline so chose not to ask that question of its applicants. College ____________________________________________ _______________ Entry Term: Fall (Jul-Dec) Spring (Jan-Jun) un) dline Deadline ______ ___________________________________________________mm/dd/yyyyo Do you intend to apply for need-based ?nancial aid? intYes Yes Yes YesNo No No No_________________ Decision Plan_____________________________ _______________________Do you intend to apply for merit-based scholarships? Do you intend to be a full-time student? Do you intend to enroll in a degree program your ?rst year?___________________ Academic Interests ____________________ _______________________________________________________ ____________________________________________________________ ______________________________ ____________________________________________________________ ______________________________Do you intend to live in college housing? ______________________________ What is the highest degree you intend to earn? _________________________Career Interest_________________________________________________ _____________________________DEMOGRAPHICS_______________________ Citizenship Status ______________________________________________ _____________________________ _________________ Non-US Citizensh __________________________ nship _____________________ ____________ _____________________________________________________________ ________________________ ______ _____________________________________________________________ _________________City/Town State/Province Country1. Are you Hispanic/Latino?Yes, Hispanic or Latino (including Spain)No If yes, please describe your background.____________________________________________________________2. Regardless of y answer to the prior question, please indicate how you identify your yourself. (Check one or more and describe your background.) American Indian or Alaska Native (including all Original Peoples of the Americas) NativeYes No If yes, please enter Tribal Enrollment Number_____________________ Birthplace ________________________________________________________ ___________ Years lived in the US? ____________ Years lived outside the US? ____________ _ Language Pro?ciency (Check all that apply.)S(Speak) R(Read) W(Write) F(First Language) H(Spoken at Home)Are you Enrolled?SRWFH____________________________________________________________ Asian (including Indian subcontinent and Philippines) ____________________________________________________________ Black or African American (including Africa and Caribbean) ____________________________________________________________ Native Hawaiian or Other Paci?c Islander (Original Peoples) ____________________________________________________________ White (including Middle Eastern) ___________________________________________________________AP-1 / 2011-12_______________________________________________ _______________________________________________ _______________________________________________ Optional The items with a gray background are optional. No information you provide will be used in a discriminatory manner.Religious Preference _______________________________________________ US Armed Services veteran status _____________________________________ Services?2011 The Common Application, Inc.FAMILYPlease 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.HouseholdParents’ marital status (relative to each other): Never Married Parent 1 Married Parent 2 Civil Union/Domestic Partners Both Legal Guardian Widowed Separated Divorced (date _________) Othermm/yyyyWith whom do you make your permanent home?Ward of the Court/StateParent 1: Mother Is Parent 1 living? YesLast/Family/SurFather Unknown No (Date Deceased ____________________)mm/yyyyParent 2: Mother Is Parent 2 living? YesLast/Family/SurFather Unknown No (Date Deceased ____________________)mm/yyyy____________________________________________________________First/Given Middle Title (Mr./Mrs./Ms./Dr.)____ ____________________________________________________________ _______First/Given Mid Middle Title (Mr./Mrs./Ms./Dr.)Country of birth ________________________________________________ Home address if different from yours ____________________________________________________________ ____________________________________________________________ Preferred Telephone: Home Cell Work (_______) ________________Area/Country/City Code_______________ Country of birth ________________________________________________ __________________ urs Home address if different from you ours __________________ ____________________________________________________________ ______________________________ ____________________________ ____________________________________________________________ ______________________________ Preferred Telephone: ne: H Home Cell (_ Work (_______) ________________ _)Are Area/Cou Area/Country/City CodeE-mail _______________________________________________________ Occupation _____________________________________________________ Employer _____________________________________________________ College (if any) ___________________________________ CEEB ________ __ Degree _________________________________________ Year _____ _______ Graduate School (if any) ____________________________ CEEB ____ EB ________ Degree ________________________________________ Year _________ __ YearLegal Guardian__________________ Relationship to you _________________________ _________________________ __________________ __________________________________ ___________________________Last/Family/Sur First/Given Middle Title (Mr./Mrs./Ms./Dr.)Country of birth ________________________________________________ _______________________________ Home address if different from yours you _________________________ ____________________________________________________________ _____________________________ _________________ ____________________________________________________________ _____________________________ Preferred Telephone: ne: H Home Ce Cell (__ __) Work (_______) ________________Area/C Area/Cou Area/Country/City CodePR EV I(if other than a parent)EWngs SiblingsName Age & Grade Name Age & Grade Name Age & Grade______________________________ E-mail _______________________________________________________ _______________________________ on ______________________ Occupation _____________________________________________________ pation ___________________________ mployer _______________________ Employer _____________________________________________________ _______ College (if any) ____________ ________________________ CEEB ________ Deg ____ Degree ______________ ____________________________ Year _________ raduate Graduate School (if any) ____________________________ CEEB ________ any _ _____________________________________ Year _________ Degree _____Pleas give names and ages of your brothers or sisters. If they are enrolled in ease gr 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. ____________________________________________________________RelationshipCollege Attended ___________________________________ CEEB _______Degree earned _________________________ Dates __________________ mm/yyyy – mm/yyyy or expected ____________________________________________________________RelationshipE-mail _______________________________________________________ ______________________________ __________ Occupation _____________________________________________________ ______________________College Attended ___________________________________ CEEB ______________ Employer _____________________________________________________ ____________College (if any) ___________________________________ CEEB ________ Degree _________________________________________ Year _________ Graduate School (if any) ____________________________ CEEB ________ Degree _________________________________________ Year _________Degree earned _________________________ Dates __________________ mm/yyyy – mm/yyyy or expected ____________________________________________________________RelationshipCollege Attended ___________________________________ CEEB _______ Degree earned _________________________ Dates __________________ mm/yyyy – mm/yyyy or expected College Attended __________________________________ CEEB ________ Degree Earned/Expected _______________________ Dates _____________mm/yyyy – mm/yyyySpouse/ChildMarital Status _____________________ Spouse’s Name __________________________________________________?If you have children, how many? _________AP-2 / 2011-122011 The Common Application, Inc.EDUC ATIONSecondary SchoolsMost recent secondary school attended ______________________________________________________________________________________________ Entry Date _________________ Graduation Date _________________mm/yyyy Number & Street mm/dd/yyyySchool Type:PublicCharterIndependentReligiousHome SchoolAddress ________________________________________________________________________________ CEEB/ACT Code ___________________________ _______________________________________________________________________________________________________________________ _______ ____City/Town State/Province Country ZIP/Postal CodeCounselor’s Name __________________________________________________________Counselor’s Title _______________________________________ _____ E-mail _____________________________________ Telephone (_______) ______________________ Fax (_______) __________________________ _______ ______Area/Country/City Code Number Ext. e Area/Country/City Code y NumberList all other secondary schools you have attended since 9th grade, including summer schools or enrichment programs hosted on a secondary scho campus: d schoolSchool Name & CEEB/ACT Code Location (City, State/Province, ZIP/Postal Code, Country) Dat Att Dates Attended (mm/yyyy)_____________________________________________ _____________________________________________ _____________________________________________________________________________________ ___________ __________ _________________ ___ ___________ ______ _____________ ____________________________________ ____________________ _________ ____________________ ________________________________ ________________________ _____ ________________process:_________________________ __________ Please list any community program/organization that has provided free assistance with your application proc process: ____________________ sect _____ If your education was or will be interrupted, please indicate so here and provide details in the Additiona Information section: ____________ onal ________________________ Cou Colleges & Universities Report all college attendance (including online) since 9th grade and indicate as College Course (CO) or Enrichment Program (EP) hosted on a g d Enrich college campus.College/University Name & CEEB/ACT Code , Location (City, State/Province, ZIP/Postal Code, Country) e, Count Degree Candidate? CO EP Yes No Dates Attended Degree Earned_________________________________ _________________________________PR EV IE W______________________________________ ___________________ _______________ ______________________ ______________________mm/yyyy – mm/yyyy______________ _______________________ _________ _______________________ _______________ _________________________________ ___________________ __________________________ Were you issued a transcript for any work listed above? Yes No If yes, please have an of?cial transcript sent as soon as possible. o riptADEM AC ADEMICS ADE M ICSThe self-reported information in this section is not intended to take the place of your of?cial records. Please note the requirements of each institution to which you are ded recor applying and arrange for of?cial transcripts and score reports to be sent from your secondary school and the appropriate testing agencies. Where “Best Scores” are e s es requested, please report the highest individual scores you have earned so far, even if those scores are from different test dates. ores ______ Weighted? Grades Class Rank _________ Class Size _________ Weig Yes No GPA _________ Scale _________ Weighted? Yes No(if available) (if available)ACTExam Dates: ________ ________ ________ _mm/yyyy mm/ mm/yyyy m mm/yyyyBest Scores: _________ ______ st(so far) COMP mm/yyyy_________ ______English mm/yyyy mm/yyyy mm/yyyy Science Math_________ ______Math Writing Writing mm/yyyy mm/yyyy mm/yyyy(past & future)_________ ______Reading mm/yyyy Critical Reading Test mm/yyyy Score_________ ______ _________ _______________ ______ _________ ______SATExam Dates: ___ __ ________ ________ ______mm/yyyy mm mm/yyyy mm/yyyyBest Scores: _________ ______(so far) (so far)(past & future) (past & future) re)TOEFL/ IELTSs: _____ Exam Dates: ________ ________ _______ es: __mm/yyyy mm/yyyy mm/yyyy yBest Score: _________ ______ ______mm/yyyy___ __________ _______________________ _____ AP/IB/SAT Best Scores: ________ _____________ t Score S yyy er subject, so far) mm/yyyy Type & Subject Score Subjects (per s _____ ________ _________ ___________________________ _____mm/yyyy mm mm/yyyy Type & Subject Type & Subject Type & Subject Score Score Score________ __________________________________ _____mm/yyyy mm/yyyy mm/yyyy mm/yyyy Type & Subject Type & Subject Type & Subject Type & Subject Score Score Score Score________ __________________________________ _____ ________ __________________________________ _____ ________ __________________________________ ________ ________ ____ _______________________________ _____mm/yyyy mm_____ __ _______ __________________________________ _____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 icathe same semester on the appropriate semester line.Full Year/First Semester/First Trimester Second Semester/Trimester Third Trimesteror additional ?rst/second term courses if more space is needed________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________?________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ______________________________________________________________________________ _ ___ ______________________________________ _ ___ ______________________________________ _ ___ ______________________________________ _ ___ ______________________________________ _ ___ ______________________________________ _ ___ ______________________________________ _ ___ ______________________________________ _ ___AP-3 / 2011-122011 The Common Application, Inc.Honors Brie?y list any academic distinctions or honors you have received since the 9 th grade or international equivalent (e.g., National Merit, Cum Laude Society).S(School) S/R(State or Regional N(National) I(International)Grade level or post-graduate (PG) 9 10 11 12 PGHonorHighest Level of Recognition S S/R N I_________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ ____ _________________________________________________________________________________________________ _____EXTRACURRICULAR ACTIVITIES & WORK EXPERIENCE NCEe gro your Extracurricular Please list your principal extracurricular, volunteer, and work activities in their order of importance to you. Feel free to group you activities and ce you.Grade level or post-graduate (PG) 9 10 11 12 PGPR EV IE WApproximate time spent 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 employerments paid work experience separately if you prefer. Use the space available to provide details of your activities and accomplishments (speci?c events, varsity letter, musical mplishments le n 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 résu ection résumé.If applicable, do you plan to participate in college?______________________ _______________________________________________________________________ ______________________________Activity _________________________________________________________________________________________________________________ ______________________________ _________________________ _______________________________________________________________________ _______________________________________________ Activity _________________________________________________________________________________________________________________ ______________________________ ________________________ _____________________________ _______________________________________________________________________Activity _________________________________________________________________________________________________________________ _____________________________ _____ ___________________ _____________________________________________________Activity _________________________________________________________________________________________________________________ ______________________________ _____ ________ _______________________________________________________________________________________ Activity _________________________________________________________________________________________________________________ ______________________________ _______________________________________________________________________Activity _________________________________________________________________________________________________________________ ____________________________ ____________________________________________________________________________ Activity _________________________________________________________________________________________________________________ _______ _______________________________________________________________________Activity _________________________________________________________________________________________________________________ _______________________________________________________________________ Activity _________________________________________________________________________________________________________________ _______________________________________________________________________ Activity _________________________________________________________________________________________________________________?2011 The Common Application, Inc.AP-4 / 2011-12WRITINGPlease brie?y elaborate on one of your extracurricular activities or work experiences in the space below. ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________ __ ____________________________________________________________________________________________________________________________ ___ ____ ____________________________________________________________________________________________________________________________ ____________ befo sub Please write an essay of 250 – 500 words on a topic of your choice or on one of the options listed below, and attach it to your application before submission. Please o apa 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, urself OTE: Comm Application grades, test scores, and other objective data. It will also demonstrate your ability to organize your thoughts and expr xpress yourself. NOTE: Your Common App wil ask 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 a for them on t a supplement form. you Evaluate a signi?cant experience, achievement, risk you have taken, or ethical dilemma you have faced and its impact on you. ha Discuss some issue of personal, local, national, or international concern and its importance to you. nce y Indicate a person who has had a signi?cant in?uence on you, and describe that in?uen uence. in?u Describe a character in ?ction, a historical ?gure, or a creative work (as in art, music, science, etc.) that has had an in?uence on you, and explain that in?uence. sic, cience, A range of academic interests, personal perspectives, and life experiences adds much to the educational mix. Given y personal background, describe an dds your experience that illustrates what you would bring to the diversity in a college community or an encounter that demonst e demonstrated the importance of diversity to you. Topic of your choice.Additional Information Please attach a separate sheet if you wish to provide details of circumstances or quali?cations not re?ected in the application. rovide ails quali?ca Disciplinary Historyn Have you ever been found responsible for a disciplinary violation at any educational institution you have attended from the 9th g on grade ( the international equivalent) (or i disciplinary action? These actions could include, but are not limited forward, whether related to academic misconduct or behavioral misconduct, that resulted in a discipl oral to: probation, suspension, removal, dismissal, or expulsion from the institution. p on f N Yes No Have you ever been adjudicated guilty or convicted of a misdemeanor, felony, or other crime? f 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, o ded, annulled, pardoned, destroyed, erased, impounded, or otherwise order by a court to be kept con?dential.] nded, ordered se pap t 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 s, nce. re?ects on what you learned from the experienc ence. Note: Applicants are expected to immediately notify the institutions to which they are applying should there be any changes to the information requested pp p mediately y whi in this application, including discipl iplinary history.Application Fee Payment If this college requires an app pplication fee, how will you be paying it?Online Paymen ment Will Mail Payment On e F Online Fee Waiver RequestSignatu Required SignatureSignature _______________________________________________________________________________________________ Date ___________________mm/dd/yyyy?2011 The Common Application, Inc.PR EV ISIGNATUREWill Mail Fee Waiver Requestinformatio I certify that all information submitted in the admission process—including the application, the personal essay, any supplements, and any other supporting t w 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 t 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 urned und gr revocation of course credit, grades, and degree, should the information I have certi?ed be false. grad 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 af?rm that I will send an enrollment deposit (or equivalent) to
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.]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.AP-5 / 2011-12EW2011-12 Teacher EvaluationFor Spring 2012 or Fall 2012 EnrollmentTETO THE APPLIC ANTAfter completing all the relevant questions below, give this form to a teacher who has taught you an academic subject (for example, English, foreign language, math, science, or social studies). If applying via mail, please also give that teacher stamped envelopes addressed to each institution that requires a Teacher Evaluation. Legal Name ___________________________________________________________________________________________________________Last/Family/Sur (Enter name exactly as it appears on official documents.) First/Given Middle (complete) Jr., etc.Female Male____ Birth Date ___________________________________________________ CAID ____________________________________________________________ _________mm/dd/yyyy__________________ Address ________________________________________________________________________________________________________________________ _______________________Number & Street Apartment # City/Town State/Province Country IP/Pos ZIP/Postal CodeCod _______________________________ School you now attend ________________________________________________________ CEEB/ACT Code _________________________ Co IMPORTANT PRIVACY NOTICE: Under the terms of the Family Educational Rights and Privacy Act (FERP after you matriculate you will have access to this form PRIV RPA), l ve 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 monap onapp.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 suppo e m 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. at s th ______________________________ Required Signature ______________________________________________ ________________________________ _______________ Date _________________amo The Common Application membership ?nds candid evaluations helpful in choosing from among highly quali?ed candidates. You are encouraged to keep this form ns subm yo in your private ?les for use should the student need additional recommendations. Please submit y references p onal your promptly, and remember to sign below before p y, of?ce m mailing directly to the college/university admission of n of?ce. Do not mail this form to The C e Common Application of?ces. __________________ Teacher’s Name (Mr./Mrs./Ms./Dr.) _______________________________________________ Subject Taught _______________________________________ _______________________________t Please print or typeSignature _________________________________________________________________________________________________ Date _____________________ ________________________________mm/dd/yyyySecondary School __________________________________________________________________________________________________________ ________________________________ _____ _________________________ School Address ________________________________________________________________________________________________________________ ________________________________Number & Street City/Town State/Province Country ZIP/Postal Code_______________ Teacher’s Telephone (_______) ___________________ one __________________________________________________ Teacher’s E-mail _____________________________________y/City Area/Country/City Code Number Ext.Background Information rmationst How long have you known this student a in what context? _______________________________________________________________________________ n and What are the ?rst words that come to your mind to describe this student? _____________________________________________________________________ me In which grade level(s) was the student enrolled when you taught him/her? 9 10 11 12 Other_____________________________________List the courses in which you have taught this student, including the level of course dif?culty (AP, IB, accelerated, honors, 100-level, 200- etc.). _________________________________________________________________________________________________________________________ ______?2011 The Common Application, Inc.PR EV IE WTH ACHER AC T O THE TEAC TO T H E TEACHERTEACHER EVALUATION 1TE-1/ 2011-12Ratings Compared to other students in his or her class year, how do you rate this student in terms of:Very good (well above average) One of the top few I’ve encounOutstanding tered (top 5%) (top 1%)No basisBelow averageAverageGood (above average)Excellent (top 10%)Intellectual promise Quality of writing Creative, original thought Productive class discussion Respect accorded by faculty Disciplined work habits Maturityding Evaluation Please write whatever you think is important about this student, including a description of academic and personal characteristics, as demonstrated in , t your classroom. We welcome information that will help us to differentiate this student from others. (Feel free to attac an additional sheet or another reference you may his attach have prepared on behalf of this student.)?2011 The Common Application, Inc.PR EV IE WMotivation Integrity Leadership Reaction to setbacks Concern for others Self-con?dence OVERALL Initiative, independence TEACHER EVALUATION 1TE-2/ 2011-122011-12 Teacher EvaluationFor Spring 2012 or Fall 2012 EnrollmentTETO THE APPLIC ANTAfter completing all the relevant questions below, give this form to a teacher who has taught you an academic subject (for example, English, foreign language, math, science, or social studies). If applying via mail, please also give that teacher stamped envelopes addressed to each institution that requires a Teacher Evaluation. Legal Name ___________________________________________________________________________________________________________Last/Family/Sur (Enter name exactly as it appears on official documents.) First/Given Middle (complete) Jr., etc.Female Male____ Birth Date ___________________________________________________ CAID ____________________________________________________________ _________mm/dd/yyyy__________________ Address ________________________________________________________________________________________________________________________ _______________________Number & Street Apartment # City/Town State/Province Country IP/Pos ZIP/Postal CodeCod _______________________________ School you now attend ________________________________________________________ CEEB/ACT Code _________________________ Co IMPORTANT PRIVACY NOTICE: Under the terms of the Family Educational Rights and Privacy Act (FERP after you matriculate you will have access to this form PRIV RPA), l ve 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 monap onapp.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 suppo e m 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. at s th ______________________________ Required Signature ______________________________________________ ________________________________ _______________ Date _________________amo The Common Application membership ?nds candid evaluations helpful in choosing from among highly quali?ed candidates. You are encouraged to keep this form ns subm your in your private ?les for use should the student need additional recommendations. Please submit yo references promptly, and remember to sign below before onal of?ce m mailing directly to the college/university admission of n of?ce. Do not mail this form to The C e Common Application of?ces. __________________ Teacher’s Name (Mr./Mrs./Ms./Dr.) _______________________________________________ Subject Taught _______________________________________ _______________________________t Please print or typeSignature _________________________________________________________________________________________________ Date _____________________ ________________________________mm/dd/yyyySecondary School __________________________________________________________________________________________________________ ________________________________ _____ _________________________ School Address ________________________________________________________________________________________________________________ ________________________________Number & Street City/Town State/Province Country ZIP/Postal Code_______________ Teacher’s Telephone (_______) ___________________ one __________________________________________________ Teacher’s E-mail _____________________________________y/City Area/Country/City Code Number Ext.Background Information rmationst How long have you known this student a in what context? _______________________________________________________________________________ n and What are the ?rst words that come to your mind to describe this student? _____________________________________________________________________ me In which grade level(s) was the student enrolled when you taught him/her? 9 10 11 12 Other_____________________________________List the courses in which you have taught this student, including the level of course dif?culty (AP, IB, accelerated, honors, 100-level, 200- etc.). _________________________________________________________________________________________________________________________ ______?2011 The Common Application, Inc.PR EV IE WTH ACHER AC T O THE TEAC TO T H E TEACHERTEACHER EVALUATION 2TE-1/ 2011-12Ratings Compared to other students in his or her class year, how do you rate this student in terms of:Very good (well above average) One of the top few I’ve encounOutstanding tered (top 5%) (top 1%)No basisBelow averageAverageGood (above average)Excellent (top 10%)Intellectual promise Quality of writing Creative, original thought Productive class discussion Respect accorded by faculty Disciplined work habits Maturityding Evaluation Please write whatever you think is important about this student, including a description of academic and personal characteristics, as demonstrated in , t your classroom. We welcome information that will help us to differentiate this student from others. (Feel free to attac an additional sheet or another reference you may his attach have prepared on behalf of this student.)?2011 The Common Application, Inc.PR EV IE WMotivation Integrity Leadership Reaction to setbacks Concern for others Self-con?dence OVERALL Initiative, independence TEACHER EVALUATION 2TE-2/ 2011-122011-12 SCHOOL REPORTFor Spring 2012 or Fall 2012 EnrollmentSRTO THE APPLIC ANTAfter completing all the relevant questions below, give this form to your secondary school counselor or another school of?cial who knows you better. If applying via mail, please also give that school of?cial stamped envelopes addressed to each institution that requires a School Report. Female Legal Name ___________________________________________________________________________________________________________ MaleLast/Family/Sur (Enter name exactly as it appears on official documents.) First/Given Middle (complete) Jr., etc.__ Birth Date ___________________________________________________ CAID ____________________________________________________________ ___mm/dd/yyyy_____ Address ________________________________________________________________________________________________________________________ ______________Number & Street Apartment # City/Town State/Province Countr Country ZIP/Postal Code__________________ School you now attend ________________________________________________________ CEEB/ACT Code _____________________________________ _________________________ re Ind Current year courses—please indicate title, level (AP, IB, advanced honors, etc.) and credit value of all courses you are taking this year. Indicate quarter rses q classes taken in the same semester on the appropriate semester line.Full Year/First Semester/First Trimester Year/ Second Semester/Second Trimester T Third Trimeste Trimesterdditional or additional ?rst/second term courses if more space is needed cours________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________________________________________________ _________________________________________________ ____________ _________ ________________________________________ ________________ ________________ ________________________________________ ___________________ _____________________ ________________________________________ _______________________ ____________________ ________________________________________ ___________________________PR EV I___________________ ________________________________________ ______________________________Please print or type Number & Street City/Town State/Province Area/Country/City Code Number Ext.__________________ ________________________________________ ______________________________t release all requested records covered under the Family Educational IMPORTANT PRIVACY NOTE: By signing this form, I authorize all schools that I have attended to re PRIV horize Rights and Privacy Act (FERPA) so that my application may be reviewed by The Common Appli n Application member institution(s) to which I am applying. inclu I further authorize the admission of?cers reviewing my application, including seasonal staff employed for the sole purpose of evaluating applications, to contact ng d of?cials at my current and former schools should they have questions about the school forms submitted on my behalf. uld I understand that under the terms of the FERPA, after I matriculate I will have acce to this form and all other recommendations and supporting documents ERPA, er access submitted by me and on my behalf, unless at least one of the following is true: ess post-matriculat 1. The institution does not save recom ommendations post-matriculation (see list monapp.org/FERPA). monapp.org/FERPA). 2. I waive my right to access below, regardless of the institution to which it is sent: ow, o Yes, I do waive my right to access, and I understand I will never se this form or any other recommendations submitted by me or on my behalf. see ht No, I do not waive my right to access, and I may someday cho e choo to see this form or any other recommendations or supporting documents submitted by me or choose n at on my behalf to the institution at which I’m enrolling, if that institution saves them after I matriculate. e in at i ___________________ Required Signature _______________________________________________________________________________________ Date _________________ re ______________________________TO T TO THE SECONDARY SCHOOL COUNSELORAttach applicant’s of?cial transcript, including c ?cial transc courses in progress, a school pro?le, and transcript legend. (Check transcript copies for readability.) Use both p g to y) pages complete y evaluation for this student. Be sure to sign below before mailing directly to the college/university admission of?ce. Do not mail this form to p your on th B The Common Application of?ces. n of?ces o Ms./Dr. Counselor’s Name (Mr./Mrs./Ms./Dr.) ________________________________________________________________________________________________ Ms./Dr.) Signature _________________________________________________________________________________________________ Date _____________________mm/dd/yyyyTitle ___________________________________________________________ School ______________________________________ _ _____________ ___ _ School Address ________________________________________________________________________________________________________________Country ZIP/Postal CodeSchool Website Address _________________________________________________________________________________________________________ Counselor’s Telephone (_______) _______________________________________ Counselor’s Fax (_______) _____________________________ _______ _ _____Area/Country/City Code NumberSchool CEEB/ACT Code ____________________________ Counselor’s E-mail _____________________________________________________________ ___ _?2011 The Common Application, Inc.EW__________________ ______________________________________ ___________________ _ ___ __ _______________ ______________________________________ _ ___ ___________ ____________ ______________________________________ _ ___________ ______________________________________ _ ________ ______________________________________ _ ____ ______________________________________ _ ___ ______________________________________ _ ___ ______________________________________ _ ___SR-1 / 2011-12Background InformationClass Rank ___________ Class Size ___________ Covering a period from __________ to __________.(mm/yyyy) (mm/yyyy)The rank isweightedunweighted. How many additional students share this rank? __________ ______ _How do you report class rank? quartile _____________ quintile _____________ decile ______________ Cumulative GPA: ________ on a _________ scale, covering a period from ____________ to _________ ___(mm/yyyy) (mm/yyyy)This GPA isweightedunweighted. The school’s passing mark is _____ ______________________ _____.(mm/dd/yyyy)Highest GPA in class ____________________________________ Graduation Date _______________ _ ___ Percentage of graduating class immediately attending: ___________four-year _______ two-year institutions _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: entPR EV IE WNo basis Below average Average Good (above ge) average) Very good Very ell (well above age) average) Excellent (top 10%)How many courses does your school offer: AP _________ IB _________ Honors _________ If school policy limits the number a student may take in a given year, please list the maximum allowed: g AP _________ IB _________ Honors _________ Is the applicant an IB Diploma candidate? Yes No Are classes taken on a block schedule? Yes No oth In comparison with othe college preparatory students h other applic at your school, the applicant’s course selection is: applican most dema emanding dem very de demanding manding dem emanding a age average w below averageOne of the top few I’ve encounOutstanding tered (top 5%) (top 1%)Extracurricular accomplishments Personal qualities and character OVERALL OVERALLstud Evaluation Please provide comments that will help us differentiate this student from others. Fe free to attach an additional sheet or another reference you have prepared for p Feel wh ca this student. Alternatively, you may attach a reference written by another school of?cial who can better describe the student. W especially welcome a broad-based assessment nce ritten We and encourage you to consider describing or addre ddressing:or other circumstances, either positiv or negative. sitiveHas the applicant ever been found respo er responsible for a disciplinary violation at your school from the 9th g grade ( the international equivalent) forward, whether related (or ) to academic misconduct or behavior misconduct, that resulted in a dis ct beh behavioral disciplinary action? These actions could include, but are not limited to: probation, suspension, removal, dismissal, or expulsion f ulsion from your institution. Yes No School policy prevents me from responding To your knowledge, has the applicant ever been adjudicated g edge j guilty or convicted of a misdemeanor, felony, or other crime? Yes No School policy prevents me from responding. [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 con?dential 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 each incident and explain the circumstances. Applicants are expected to immediately notify the institutions to which they are applying should there be any changes to the information requested in this application, including disciplinary history. Check here if you would prefer to discuss this applicant over the phone with each admission office. I recommend this student:?No basisWith reservationFairly stronglyStronglyEnthusiasticallySR-2/ 2011-122011 The Common Application, Inc.2011-12 MIDYEAR ReportFor Spring 2012 or Fall 2012 EnrollmentMRTO THE APPLIC ANTAfter completing the information in this section, give this form to your school counselor or another school of?cial who knows you better. If applying via mail, please also give that school of?cial stamped envelopes addressed to each institution to which you have applied. Female Legal Name ___________________________________________________________________________________________________________ MaleLast/Family/Sur (Enter name exactly as it appears on official documents.) First/Given Middle (complete) Jr., etc.____ Birth Date ___________________________________________________ CAID ____________________________________________________________ _____mm/dd/yyyy_____ Address ________________________________________________________________________________________________________________________ ________________Number & Street Apartment # City/Town State/Province ce ountry Country ZIP/Postal Code_________________ School you now attend ________________________________________________________ CEEB/ACT Code _____________________________________ ___________________________ yo IMPORTANT PRIVACY NOTE: In accordance with the Family Educational Rights and Privacy Act ( PRIV y g y (FERPA), the original School Report submitted on y behalf ) he g p you your re?ects y choice to waive or not waive y right of access to all recommendations and supporting documents. That response applies to all subsequent reports, your your su inc including this one. You chose the following: g g 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. y g y ommendations y y doc No, I do not waive my right to access, and I may someday choose to see this form or any other recommendations or supporting docu y g y y y ther documents submitted by me or matricula on my behalf to the institution at which I enrolling, if that institution saves them after I matriculate. at matO CO UNSELO TO THE SCHOOL COUNSELOR OO L C O UNSEL O RPlease submit this form when midyear grades are available (end of ?rst semester or second trimester). Attach applican of?cial transcript, including courses ester r applicant’s in progress and transcript legend. (Please check transcript copies for readabi ability.) Be sure to sign below before mailing directly to the college/university ma admission of?ce. Do not mail this form to The Common Application of?ces. no ___________________ Counselor’s Name (Mr./Mrs./Ms./Dr.) ________________________________________________________________________________________________ _____________________________ _____________________________ Signature _________________________________________________________________________________________________ Date _____________________ _________________________________mm/dd/yyyy_________________ l Title ______________________________________ ________________________ School ______________________________________ ol _ _____________ ___ _ ______________________ School Address ________________________________________________________________________________________________________________ _____________________________Number & Street City/Town City/To State/Province Country ZIP/Postal CodeSchool Website Address _________________________________________________________________________________________________________ ______________________________ Counselor’s Telephone (_______) _______________________________ _______________________________________ Counselor’s Fax (_______) _____________________________ _______ _ _____Area/Country/City Code ntry/City N Number Ext. Area/Country/City Code Number___________________________ School CEEB/ACT Code ____________________________________ Counselor’s E-mail _____________________________________________________ ___ ________________________________ _format inform Background Information If any of the information belo has changed for this student since the School Report was submitted, please enter the new information in formation elowthe appropriate section below. se_ __ Class Rank _______ Class Size ______ Covering a period from _______ to ______.(mm/yyyy) (mm/yyyy)PR EVYes NoPlease print or typeIE WThis GPA is weighted Yes NoCumulative GPA: _____ on a _____ scale, covering a period from _______ to ______.(mm/yyyy) (mm/yyyy)unwe The rank is weighted unweighted. t rank?_________ How many additional students share this r ts _unweighted. The school’s passing mark is _____________.(mm/dd/yyyy)We do not rank. Instead, please indicate quartile ____ quintile ____ decile ______ inHighest GPA in class _____________________ Graduation Date ________________Have there been any changes to the senior year courses listed on the original School Report?Hav here en any Have there been a y changes in the applicant’s disciplinary status at your school since you submitted the original School Report? g pp p y Yes No School policy prevents me from responding To y kno edge have there been any changes to the applicant’s criminal history since you submitted the original School Report? your knowledge, y g pp Yes No School policy prevents me from responding Do you wish to update your original evaluation of this applicant? 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.?2011 The Common Application, Inc.MR-1 / 2011-122011-12 ?nal ReportFor Spring 2012 or Fall 2012 EnrollmentFRTO THE APPLIC ANTAfter completing the information in this section, give this form to your school counselor or another school of?cial who knows you better. If applying via mail, please also give that school of?cial stamped envelopes addressed to all institutions requesting a ?nal transcript. Female Legal Name ___________________________________________________________________________________________________________ MaleLast/Family/Sur (Enter name exactly as it appears on official documents.) First/Given Middle (complete) Jr., etc.Birth Date ___________________________________________________ CAID ____________________________________________________________ ____mm/dd/yyyy_____ Address ________________________________________________________________________________________________________________________ _______________Number & Street Apartment # City/Town State/Province e Country ZIP/Postal Code_________________ School you now attend ________________________________________________________ CEEB/ACT Code _____________________________________ __________________________yo IMPORTANT PRIVACY NOTE: In accordance with the Family Educational Rights and Privacy Act ( PRIV y g y (FERPA), the original School Report submitted on y behalf ) he g p you your re?ects y choice to waive or not waive y right of access to all recommendations and supporting documents. That response applies to all subsequent reports, your your su inc including this one. You chose the following: g g 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. y g y ommendations y y doc No, I do not waive my right to access, and I may someday choose to see this form or any other recommendations or supporting docu y g y y y ther documents submitted by me or matricula on my behalf to the institution at which I enrolling, if that institution saves them after I matriculate. at matO CO UNSELO TO THE SCHOOL COUNSELOR OO L C O UNSEL O RPlease submit this form when ?nal grades are available (end of second semester or third trimester). Attach applicant’s of?cial transcript and transcript legend. ster r ng (Please check transcript copies for readability.) Be sure to sign below before mailing directly to the college/univ fore college/university admission of?ce. Do not mail this form to The Common Application of?ces. ____________________ Counselor’s Name (Mr./Mrs./Ms./Dr.) ________________________________________________________________________________________________ ______________________________ _____________________________ Signature _________________________________________________________________________________________________ Date _____________________ _________________________________mm/dd/yyyy________________ Title ______________________________________ _______________________ School ______________________________________ ol _ _____________ ___ _ _______________________ School Address ________________________________________________________________________________________________________________ ______________________________Number & Street City/Town City/To State/Province Country ZIP/Postal CodeSchool Website Address _________________________________________________________________________________________________________ ______________________________ Counselor’s Telephone (_______) _______________________________ _______________________________________ Counselor’s Fax (_______) _____________________________ _______ _ _____Area/Country/City Code ntry/City N Number Ext. Area/Country/City Code Number__________________________ School CEEB/ACT Code __________________________________ Counselor’s E-mail _____________________________________________________ ____ _______________________________ _ inform Background Information If any of the information belo has changed for this student since the Midyear Report was submitted, please enter the new information formation elow in the appropriate section below. ate sectClass Rank _______ Class Size ______ Covering a period from _______ to ______. __ __(mm/yyyy) (mm/yyyy)PR EVYes NoPlease print or typeIE WThis GPA is weighted Yes NoCumulative GPA: _____ on a _____ scale, covering a period from _______ to ______.(mm/yyyy) (mm/yyyy)unwe The rank is weighted unweighted. How many additional students share this ra ts rank?_________ _unweighted. The school’s passing mark is _____________.(mm/dd/yyyy)We do not rank. Instead, please in indicate quartile ____ quintile ____ decile ______Highest GPA in class _____________________ Graduation Date ________________Have there been any changes to the senior year courses listed on the original School Report?Hav here en any Have there been a changes in the applicant’s disciplinary status at your school since you submitted the original School Report? g Yes No School policy prevents me from responding To y kno edge have there been any changes to the applicant’s criminal history since you submitted the original School Report? your knowledge, y g pp Yes No School policy prevents me from responding Do you wish to update your original evaluation of this applicant? 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.?2011 The Common Application, Inc.FR-1 / 2011-12
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