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Form Name:   Common_App
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Date:   10/29/2011
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2011-12 First-year ApplicationFor Spring 2012 or Fall 2012 EnrollmentAP-1/2011-12© 2011 The Common Application, Inc.APPLICANTLegal Name ___________________________________________________________________________________________________________________þÿ Last/Family/Sur (Enter name exactly as it appears on official documents.)þÿ First/Given þÿ Middle (complete)þÿ Jr., etc.Preferred name, if not rst name (only one)þÿ_ ____________________________þÿ Former last name(s) _____________________________________________Birth Dateþÿ_ ____________________________________________________þÿ US Social Security Number, if any ___________________________________þÿ mm/dd/yyyyþÿ Required for US Citizens and Permanent Residents applying for financial aid via FAFSAPreferred Telephone  Home  Cell Home (_______) __________________________________ Cell (_______) __________________________________þÿ Area/Country/City Codeþÿ Area/Country/City CodeE-mail Address þÿ_ ________________________________________________þÿ IM Address ____________________________________________________Permanent home address __________________________________________________________________________________________________________þÿ Number & Streetþÿ Apartment #____________________________________________________________________________________________________________________________City/Townþÿ County or Parishþÿ State/Provinceþÿ Countryþÿ ZIP/Postal CodeIf different from above, please give your current mailing address for all admission correspondence. (from ___________ to ___________)þÿ (mm/dd/yyyy)þÿ (mm/dd/yyyy)Current mailing address __________________________________________________________________________________________________________þÿ Number & Streetþÿ Apartment #____________________________________________________________________________________________________________________________City/Townþÿ County or Parishþÿ State/Provinceþÿ Countryþÿ ZIP/Postal CodeIf your current mailing address is a boarding school, include name of school here: _________________________________________________________________FUTURE PLANSYour answers to these questions will vary for different colleges. If the online system did not ask you to answer some of the questions you see in this section, this college chose not to ask that question of its applicants. College ________________________________________________________þÿ Deadline ______________________________________________________þÿ mm/dd/yyyyEntry Term:  Fall (Jul-Dec)  Spring (Jan-Jun)Decision Planþÿ_ ___________________________________________________Academic Interestsþÿ_ _____________________________________________________________________________________________________________________________________________________________________Career Interestþÿ_ _________________________________________________Do you intend to apply for need-based nancial aid?þÿ  Yes  NoDo you intend to apply for merit-based scholarships?þÿ  Yes  NoDo you intend to be a full-time student?þÿ  Yes  NoDo you intend to enroll in a degree program your rst year?þÿ  Yes  NoDo you intend to live in college housing?þÿ_ ______________________________What is the highest degree you intend to earn?þÿ_ _________________________DþÿeEMOGþÿrapRAPHþÿicICS  Female  MaleCitizenship Statusþÿ_ ______________________________________________Non-US Citizenshipþÿ_ ________________________________________________________________________________________________________________________________________________________________________Birthplaceþÿ_ ________________________________________________________ City/Town State/Province CountryYears lived in the US? ____________ Years lived outside the US? __________þÿ_ __Language Prociency (Check all that apply.)S(Speak) R(Read) W(Write) F(First Language) H(Spoken at Home)þÿ Sþÿ Rþÿ Wþÿ Fþÿ H_______________________________________________þÿ þÿ þÿ þÿ þÿ _______________________________________________þÿ þÿ þÿ þÿ þÿ _______________________________________________þÿ þÿ þÿ þÿ þÿ Optional The items with a gray background are optional. No information you provide will be used in a discriminatory manner.Religious Preference þÿ_ _______________________________________________US Armed Services veteran statusþÿ_ _____________________________________1. þÿ Are you Hispanic/Latino?þÿ Yes, Hispanic or Latino (including Spain)  No If yes, please describe your background.þÿ_ ____________________________________________________________2. þÿ Regardless of your answer to the prior question, please indicate how you identify yourself. (Check one or more and describe your background.)þÿ American Indian or Alaska Native (including all Original Peoples of the Americas)Are you Enrolled?  Yes  No If yes, please enter Tribal Enrollment Number________________þÿ_ ____________________________________________________________þÿ Asian (including Indian subcontinent and Philippines)þÿ_ ____________________________________________________________þÿ Black or African American (including Africa and Caribbean)þÿ_ ____________________________________________________________þÿ Native Hawaiian or Other Pacic Islander (Original Peoples)þÿ_ ____________________________________________________________þÿ White (including Middle Eastern)þÿ þÿ_ ___________________________________________________________AP-2/2011-12© 2011 The Common Application, Inc.FAþÿMMILYPlease 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  Married  Civil Union/Domestic Partners  Widowed  Separated  Divorced (date _________)þÿ mm/yyyyWith whom do you make your permanent home?  Parent 1  Parent 2  Both  Legal Guardian  Ward of the Court/State  OtherIf you have children, how many? _________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 yours________________________________________________________________________________________________________________________Preferred Telephone:  Home  Cell  Work (_______)þÿ_ ________________þÿ Area/Country/City Code E-mail _______________________________________________________Occupation _____________________________________________________Employer _____________________________________________________College (if any) þÿ_ ___________________________________þÿ CEEB________Degree þÿ_ _________________________________________þÿ Year _________Graduate School (if any) þÿ_ ____________________________þÿ CEEB________Degree þÿ_ _________________________________________þÿ Year _________SiblingsPlease give names and ages of your brothers or sisters. If they are enrolled in grades K-12 (or international equivalent), list their grade levels. If they have attended or are currently attending college, give the names of the undergraduate institution, degree earned, and approximate dates of attendance. If more than three siblings, please list them in the Additional Information section.____________________________________________________________Nameþÿ Age & Gradeþÿ RelationshipCollege Attendedþÿ_ ___________________________________ CEEB _______Degree earned _________________________ Datesþÿ_ __________________or expectedþÿ mm/yyyy – mm/yyyy____________________________________________________________Nameþÿ Age & Gradeþÿ RelationshipCollege Attendedþÿ_ ___________________________________ CEEB _______Degree earned _________________________ Datesþÿ_ __________________or expectedþÿ mm/yyyy – mm/yyyy____________________________________________________________Nameþÿ Age & Gradeþÿ RelationshipCollege Attendedþÿ_ ___________________________________ CEEB _______Degree earned _________________________ Datesþÿ_ __________________or expectedþÿ mm/yyyy – mm/yyyyParent 1:  Mother  Father  UnknownIs Parent 1 living?  Yes  No (Date Deceased ____________________)þÿ 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 (_______)þÿ_ ________________þÿ Area/Country/City Code E-mail _______________________________________________________Occupation _____________________________________________________Employer _____________________________________________________College (if any) þÿ_ ___________________________________þÿ CEEB________Degree þÿ_ _________________________________________þÿ Year _________Graduate School (if any) þÿ_ ____________________________þÿ CEEB________Degree þÿ_ _________________________________________þÿ Year _________Parent 2:  Mother  Father  UnknownIs Parent 2 living?  Yes  No (Date Deceased ____________________)þÿ 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 (_______)þÿ_ ________________þÿ Area/Country/City Code E-mail _______________________________________________________Occupation _____________________________________________________Employer _____________________________________________________College (if any) þÿ_ ___________________________________þÿ CEEB________Degree þÿ_ _________________________________________þÿ Year _________Graduate School (if any) þÿ_ ____________________________þÿ CEEB________Degree þÿ_ _________________________________________þÿ Year _________AP-3/2011-12© 2011 The Common Application, Inc.EDUCATIþÿOONSecondary SchoolsMost recent secondary school attendedþÿ_ ______________________________________________________________________________________________Entry Date _________________ Graduation Date _________________ School Type:  Public  Charter  Independent  Religious  Home Schoolþÿ mm/yyyyþÿ mm/dd/yyyyAddress ________________________________________________________________________________ CEEB/ACT Code ___________________________þÿ Number & Streetþÿ __________________________________________________________________________________________________________________________________þÿ þÿ City/Townþÿ State/Provinceþÿ Countryþÿ ZIP/Postal CodeCounselor’s Name __________________________________________________________þÿ Counselor’s Title _______________________________________E-mail _____________________________________ Telephone (_______) ______________________ Fax (_______) ________________________________ þÿ Area/Country/City Code Number Ext.þÿ Area/Country/City Code NumberList all other secondary schools you have attended since 9th grade, including summer schools or enrichment programs hosted on a secondary school campus:þÿ School Name & CEEB/ACT Codeþÿ Location (City, State/Province, ZIP/Postal Code, Country)þÿ Dates Attended (mm/yyyy)_____________________________________________þÿ _______________________________________________________þÿ _________________________________________________________________þÿ _______________________________________________________þÿ _________________________________________________________________þÿ _______________________________________________________þÿ ____________________Please list any community program/organization that has provided free assistance with your application process:þÿ_ ____________________________________________If your education was or will be interrupted, please indicate so here and provide details in the Additional Information section:þÿ_ ___________________________________Colleges & Universities Report all college attendance (including online) since 9th grade and indicate as College Course (CO) or Enrichment Program (EP) hosted on a college campus.þÿ College/University Name & CEEB/ACT Codeþÿ Location (City, State/Province, ZIP/Postal Code, Country)þÿ Degree Candidate?þÿ CO EPþÿ Dates Attendedþÿ Degree Earned þÿ Yes Noþÿ mm/yyyy – mm/yyyy_________________________________ ___________________________________________   ______________ __________________________________________ ___________________________________________   ______________ __________________________________________ ___________________________________________   ______________ _________Were you issued a transcript for any work listed above?  Yes  No If yes, please have an ofcial transcript sent as soon as possible.ACADEþÿMMICSThe self-reported information in this section is not intended to take the place of your ofcial records. Please note the requirements of each institution to which you are applying and arrange for ofcial transcripts and score reports to be sent from your secondary school and the appropriate testing agencies. Where “Best Scores” are requested, please report the highest individual scores you have earned so far, even if those scores are from different test dates.Grades þÿ Class Rank _________ Class Size _________ Weighted?  Yes  Noþÿ GPA _________ Scale _________ Weighted?  Yes  Noþÿ (if available)þÿ (if available)ACTþÿ Exam Dates: ________ ________ ________þÿ Best Scores: _________ ______ _________ ______ _________ ______þÿ (past & future) þÿ mm/yyyyþÿ mm/yyyyþÿ mm/yyyyþÿ (so far)þÿ COMPþÿ mm/yyyyþÿ Englishþÿ mm/yyyyþÿ Mathþÿ mm/yyyyþÿ _________ ______ _________ ______ _________ ______þÿ Readingþÿ mm/yyyyþÿ Scienceþÿ mm/yyyyþÿ Writingþÿ mm/yyyySATþÿ Exam Dates: ________ ________ ________þÿ Best Scores: _________ ______ _________ ______ _________ ______þÿ (past & future) þÿ mm/yyyyþÿ mm/yyyyþÿ mm/yyyyþÿ (so far)þÿ Critical Readingþÿ mm/yyyyþÿ Mathþÿ mm/yyyyþÿ Writingþÿ mm/yyyyTOEFL/þÿ Exam Dates: ________ ________ ________þÿ Best Score: _________ ______ ______IELTSþÿ (past & future) þÿ mm/yyyyþÿ mm/yyyyþÿ mm/yyyyþÿ (so far) þÿ Testþÿ Scoreþÿ mm/yyyy þÿ AP/IB/SAT Subjectsþÿ Best Scores: ________ __________________________________ _____ ________ __________________________________ _____þÿ (per subject, so far)þÿ mm/yyyy þÿ Type & Subjectþÿ Score þÿ mm/yyyy þÿ Type & Subjectþÿ Score þÿ ________ __________________________________ _____ ________ __________________________________ _____ þÿ mm/yyyy þÿ Type & Subjectþÿ Score þÿ mm/yyyy þÿ Type & Subjectþÿ Score þÿ ________ __________________________________ _____ ________ __________________________________ _____ þÿ mm/yyyy þÿ Type & Subjectþÿ Score þÿ mm/yyyy þÿ Type & Subjectþÿ Score þÿ ________ __________________________________ _____ ________ __________________________________ _____ þÿ mm/yyyy þÿ Type & Subjectþÿ Score þÿ mm/yyyy þÿ Type & Subjectþÿ Score Current Courses Please indicate title, level (AP, IB, advanced honors, etc.) and credit value of all courses you are taking this year. Indicate quarter classes taken in the same semester on the appropriate semester line.þÿ Full Year/First Semester/First Trimesterþÿ Second Semester/Trimesterþÿ Third Trimesterþÿ or additional rst/second term courses if more space is needed________________________________________ ________________________________________ _________________________________________________________________________________ ________________________________________ _________________________________________________________________________________ ________________________________________ _________________________________________________________________________________ ________________________________________ _________________________________________________________________________________ ________________________________________ _________________________________________________________________________________ ________________________________________ _________________________________________________________________________________ ________________________________________ _________________________________________________________________________________ ________________________________________ _________________________________________AP-4/2011-12© 2011 The Common Application, Inc.Honors Briey list any academic distinctions or honors you have received since the 9th 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)HonorHighest Level of Recognition 9101112PGSS/RNI_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________EXþÿtracurricularTRACURRICULAR AþÿctiCTIVþÿitiesITIES & WOþÿrRK EXþÿperiencePERIENCEExtracurricular Please list your principal extracurricular, volunteer, and work activities in their order of importance to you. Feel free to group your activities and paid work experience separately if you prefer. Use the space available to provide details of your activities and accomplishments (specic events, varsity letter, musical instrument, employer, etc.). To allow us to focus on the highlights of your activities, please complete this section even if you plan to attach a résumé.Grade level or post-graduate (PG)Approximate time spentWhen did you participate in the activity?Positions held, honors won, letters earned, or employerIf applicable, do you plan to participate in college?9101112PGHours per weekWeeks per yearSchool yearSummer/School Break_______________________________________________________________________ Activityþÿ_ ________________________________________________________________________________________________________________________________________________________________________________________ Activityþÿ_ ________________________________________________________________________________________________________________________________________________________________________________________ Activityþÿ_ ________________________________________________________________________________________________________________________________________________________________________________________ Activityþÿ_ ________________________________________________________________________________________________________________________________________________________________________________________ Activityþÿ_ ________________________________________________________________________________________________________________________________________________________________________________________ Activityþÿ_ ________________________________________________________________________________________________________________________________________________________________________________________ Activityþÿ_ ________________________________________________________________________________________________________________________________________________________________________________________ Activityþÿ_ ________________________________________________________________________________________________________________________________________________________________________________________ Activityþÿ_ ________________________________________________________________________________________________________________________________________________________________________________________ Activityþÿ_ _________________________________________________________________________________________________________________AP-5/2011-12© 2011 The Common Application, Inc.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.WRITINþÿGGPlease briey elaborate on one of your extracurricular activities or work experiences in the space below.____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________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 indicate your topic by checking the appropriate box. This personal essay helps us become acquainted with you as a person and student, apart from courses, grades, test scores, and other objective data. It will also demonstrate your ability to organize your thoughts and express yourself. NOTE: Your Common Application essay should be the same for all colleges. Do not customize it in any way for individual colleges. Colleges that want customized essay responses will ask for them on a supplement form.þÿ Evaluate a signicant experience, achievement, risk you have taken, or ethical dilemma you have faced and its impact on you.þÿ Discuss some issue of personal, local, national, or international concern and its importance to you.þÿ Indicate a person who has had a signicant inuence on you, and describe that inuence.þÿ Describe a character in ction, a historical gure, or a creative work (as in art, music, science, etc.) that has had an inuence on you, and explain that inuence.þÿ þÿA range of academic interests, personal perspectives, and life experiences adds much to the educational mix. Given your personal background, describe an experience that illustrates what you would bring to the diversity in a college community or an encounter that demonstrated the importance of diversity to you.þÿ Topic of your choice.Additional Information Please attach a separate sheet if you wish to provide details of circumstances or qualications not reected in the application.Disciplinary History þÿ Have you ever been found responsible for a disciplinary violation at any educational institution you have attended from the 9th grade (or the international equivalent) forward, whether related to academic misconduct or behavioral misconduct, that resulted in a disciplinary action? These actions could include, but are not limited to: probation, suspension, removal, dismissal, or expulsion from the institution.  Yes  No þÿ Have you ever been adjudicated guilty or convicted of a misdemeanor, felony, or other crime?  Yes  No [Note that you are not required to answer “yes” to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise ordered by a court to be kept condential.]If you answered “yes” to either or both questions, please attach a separate sheet of paper that gives the approximate date of each incident, explains the circumstances, and reects on what you learned from the experience.Note: 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.SIþÿGGNATUREApplication Fee Payment If this college requires an application fee, how will you be paying it? Online Payment  Will Mail Payment  Online Fee Waiver Request  Will Mail Fee Waiver RequestRequired Signatureþÿ I certify that all information submitted in the admission process—including the application, the personal essay, any supplements, and any other supporting materials—is my own work, factually true, and honestly presented, and that these documents will become the property of the institutions to which I am applying and will not be returned to me. I understand that I may be subject to a range of possible disciplinary actions, including admission revocation, expulsion, or revocation of course credit, grades, and degree, should the information I have certied be false.þÿ 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.þÿ I afrm that I will send an enrollment deposit (or equivalent) to only one institution; sending multiple deposits (or equivalent) may result in the withdrawal of my admission offers from all institutions. [Note: students may send an enrollment deposit (or equivalent) to a second institution where they have been admitted from the waitlist, provided that they inform the rst institution that they will no longer be enrolling.]Signature _______________________________________________________________________________________________ Date ___________________þÿ mm/dd/yyyy© 2011 The Common Application, Inc.TE-1/2011-12TþÿOO TþÿHHE APPLICANTAfter 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 ___________________________________________________________________________________________________________________þÿ Last/Family/Sur (Enter name exactly as it appears on official documents.)þÿ First/Given þÿ Middle (complete)þÿ Jr., etc.Birth Date _______________________________________________________________þÿ mm/dd/yyyyAddress ________________________________________________________________________________________________________________________ Number & Street Apartment #þÿ City/Townþÿ State/Provinceþÿ Countryþÿ ZIP/Postal CodeSchool you now attend ________________________________________________________þÿ CEEB/ACT Code _____________________________________TþÿeacherEACHER þÿeEVþÿaluationALUATION 1TþÿOO TþÿHHE TEACþÿHHERThe Common Application membership nds candid evaluations helpful in choosing from among highly qualied candidates. You are encouraged to keep this form in your private les for use should the student need additional recommendations. Please submit your references promptly, and remember to sign below before mailing directly to the college/university admission ofce. Do not mail this form to The Common Application ofces.Teacher’s Name (Mr./Mrs./Ms./Dr.) _______________________________________________ Subject Taught _______________________________________þÿ Please print or typeSignature _________________________________________________________________________________________________ Date _____________________þÿ mm/dd/yyyySecondary School _______________________________________________________________________________________________________________School Address ________________________________________________________________________________________________________________þÿ Number & Streetþÿ City/Townþÿ State/Provinceþÿ Countryþÿ ZIP/Postal CodeTeacher’s Telephone (_______) __________________________________________________þÿ Teacher’s E-mail _____________________________________þÿ Area/Country/City Codeþÿ Numberþÿ Ext.Background InformationHow long have you known this student and in what context?þÿ_ _______________________________________________________________________________ What are the rst words that come to your mind to describe this student?þÿ_ _____________________________________________________________________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 difculty (AP, IB, accelerated, honors, elective; 100-level, 200-level; etc.)._______________________________________________________________________________________________________________________________2011-12 Teacher EvaluationFor Spring 2012 or Fall 2012 Enrollment Female  MaleTEIMPORTANT PRIþÿVVACY NOTICE: Under the terms of the Family Educational Rights and Privacy Act (FERPA), after you matriculate you will have access to this form and all other recommendations and supporting documents submitted by you and on your behalf, unless at least one of the following is true:1. The institution does not save recommendations post-matriculation (see list at www.commonapp.org/FERPA). 2. You waive your right to access below, regardless of the institution to which it is sent:þÿ 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.þÿ No, I do not waive my right to access, and I may someday choose to see this form or any other recommendations or supporting documents submitted by me or on my behalf to the institution at which I'm enrolling, if that institution saves them after I matriculate.Required Signature _______________________________________________________________________________________ Date _________________© 2011 The Common Application, Inc.TE-2/2011-12Ratings Compared to other students in his or her class year, how do you rate this student in terms of:No basisBelow averageAverageGood (above average)þÿVVery good (well above average)Excellent (top 10%)Outstanding (top 5%)One of the top few I’ve encoun-tered (top 1%)Academic achievementIntellectual promiseQuality of writingCreative, original thoughtProductive class discussionRespect accorded by facultyDisciplined work habitsMaturityMotivationLeadershipIntegrityReaction to setbacksConcern for othersSelf-condenceInitiative, independenceOVþÿerallERALLEvaluation Please write whatever you think is important about this student, including a description of academic and personal characteristics, as demonstrated in your classroom. We welcome information that will help us to differentiate this student from others. (Feel free to attach an additional sheet or another reference you may have prepared on behalf of this student.)TþÿeacherEACHER þÿeEVþÿaluationALUATION 1© 2011 The Common Application, Inc.TE-1/2011-12TþÿOO TþÿHHE APPLICANTAfter 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 ___________________________________________________________________________________________________________________þÿ Last/Family/Sur (Enter name exactly as it appears on official documents.)þÿ First/Given þÿ Middle (complete)þÿ Jr., etc.Birth Date _______________________________________________________________þÿ mm/dd/yyyyAddress ________________________________________________________________________________________________________________________ Number & Street Apartment #þÿ City/Townþÿ State/Provinceþÿ Countryþÿ ZIP/Postal CodeSchool you now attend ________________________________________________________þÿ CEEB/ACT Code _____________________________________TþÿeacherEACHER þÿeEVþÿaluationALUATION 2TþÿOO TþÿHHE TEACþÿHHERThe Common Application membership nds candid evaluations helpful in choosing from among highly qualied candidates. You are encouraged to keep this form in your private les for use should the student need additional recommendations. Please submit your references promptly, and remember to sign below before mailing directly to the college/university admission ofce. Do not mail this form to The Common Application ofces.Teacher’s Name (Mr./Mrs./Ms./Dr.) _______________________________________________ Subject Taught _______________________________________þÿ Please print or typeSignature _________________________________________________________________________________________________ Date _____________________þÿ mm/dd/yyyySecondary School _______________________________________________________________________________________________________________School Address ________________________________________________________________________________________________________________þÿ Number & Streetþÿ City/Townþÿ State/Provinceþÿ Countryþÿ ZIP/Postal CodeTeacher’s Telephone (_______) __________________________________________________þÿ Teacher’s E-mail _____________________________________þÿ Area/Country/City Codeþÿ Numberþÿ Ext.Background InformationHow long have you known this student and in what context?þÿ_ _______________________________________________________________________________ What are the rst words that come to your mind to describe this student?þÿ_ _____________________________________________________________________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 difculty (AP, IB, accelerated, honors, elective; 100-level, 200-level; etc.)._______________________________________________________________________________________________________________________________2011-12 Teacher EvaluationFor Spring 2012 or Fall 2012 Enrollment Female  MaleTEIMPORTANT PRIþÿVVACY NOTICE: Under the terms of the Family Educational Rights and Privacy Act (FERPA), after you matriculate you will have access to this form and all other recommendations and supporting documents submitted by you and on your behalf, unless at least one of the following is true:1. The institution does not save recommendations post-matriculation (see list at www.commonapp.org/FERPA). 2. You waive your right to access below, regardless of the institution to which it is sent:þÿ 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.þÿ No, I do not waive my right to access, and I may someday choose to see this form or any other recommendations or supporting documents submitted by me or on my behalf to the institution at which I'm enrolling, if that institution saves them after I matriculate.Required Signature _______________________________________________________________________________________ Date _________________© 2011 The Common Application, Inc.TE-2/2011-12Ratings Compared to other students in his or her class year, how do you rate this student in terms of:No basisBelow averageAverageGood (above average)þÿVVery good (well above average)Excellent (top 10%)Outstanding (top 5%)One of the top few I’ve encoun-tered (top 1%)Academic achievementIntellectual promiseQuality of writingCreative, original thoughtProductive class discussionRespect accorded by facultyDisciplined work habitsMaturityMotivationLeadershipIntegrityReaction to setbacksConcern for othersSelf-condenceInitiative, independenceOVþÿerallERALLEvaluation Please write whatever you think is important about this student, including a description of academic and personal characteristics, as demonstrated in your classroom. We welcome information that will help us to differentiate this student from others. (Feel free to attach an additional sheet or another reference you may have prepared on behalf of this student.)TþÿeacherEACHER þÿeEVþÿaluationALUATION 2© 2011 The Common Application, Inc.2011-12 SCHOOL REPORTFor Spring 2012 or Fall 2012 EnrollmentTO þÿtTHþÿeE þÿapplicantAPPLICANTAfter completing all the relevant questions below, give this form to your secondary school counselor or another school ofcial who knows you better. If applying via mail, please also give that school ofcial stamped envelopes addressed to each institution that requires a School Report. Legal Name ___________________________________________________________________________________________________________________þÿ Last/Family/Sur (Enter name exactly as it appears on official documents.)þÿ First/Given þÿ Middle (complete)þÿ Jr., etc.Birth Date ___________________________________________________þÿ mm/dd/yyyyAddress ________________________________________________________________________________________________________________________þÿ Number & Street Apartment #þÿ City/Townþÿ State/Provinceþÿ Countryþÿ ZIP/Postal CodeSchool you now attend ________________________________________________________þÿ CEEB/ACT Code _____________________________________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 classes taken in the same semester on the appropriate semester line.þÿ Full Year/First Semester/First Trimesterþÿ Second Semester/Trimesterþÿ Third Trimesterþÿ or additional rst/second term courses if more space is needed________________________________________ ________________________________________ _________________________________________________________________________________ ________________________________________ _________________________________________________________________________________ ________________________________________ _________________________________________________________________________________ ________________________________________ _________________________________________________________________________________ ________________________________________ _________________________________________________________________________________ ________________________________________ _________________________________________________________________________________ ________________________________________ _________________________________________________________________________________ ________________________________________ _________________________________________SR-1/2011-12TO þÿtTHþÿeE SECþÿOONDARY SCþÿHOOHOOL CþÿOOUNSELþÿOORAttach applicant’s ofcial transcript, including courses in progress, a school prole, and transcript legend. (Check transcript copies for readability.) Use both pages to complete your evaluation for this student. Be sure to sign below before mailing directly to the college/university admission ofce. Do not mail this form to The Common Application ofces.Counselor’s Name (Mr./Mrs./Ms./Dr.) þÿ_ ________________________________________________________________________________________________þÿ Please print or typeSignature _________________________________________________________________________________________________ Date _____________________þÿ mm/dd/yyyyTitle ___________________________________________________________þÿ School _______________________________________________________School Address þÿ_ ________________________________________________________________________________________________________________þÿ Number & Street þÿ City/Townþÿ State/Provinceþÿ Countryþÿ ZIP/Postal CodeSchool Website Address þÿ_ _________________________________________________________________________________________________________Counselor’s Telephone (_______) ________________________________________ Counselor’s Fax (_______) _________________________________________þÿ Area/Country/City Codeþÿ Numberþÿ Ext.þÿ Area/Country/City Code þÿ NumberSchool CEEB/ACT Code ____________________________ Counselor’s E-mail _________________________________________________________________ Female  MaleSRIMPORTANT PRIþÿVVACY NOTE: By signing this form, I authorize all schools that I have attended to release all requested records covered under the Family Educational Rights and Privacy Act (FERPA) so that my application may be reviewed by The Common Application member institution(s) to which I am applying. I further authorize the admission ofcers reviewing my application, including seasonal staff employed for the sole purpose of evaluating applications, to contact ofcials at my current and former schools should they have questions about the school forms submitted on my behalf.I understand that under the terms of the FERPA, after I matriculate I will have access to this form and all other recommendations and supporting documents submitted by me and on my behalf, unless at least one of the following is true:1. The institution does not save recommendations post-matriculation (see list at www.commonapp.org/FERPA). 2. I waive my right to access below, regardless of the institution to which it is sent:þÿ 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.þÿ No, I do not waive my right to access, and I may someday choose to see this form or any other recommendations or supporting documents submitted by me or on my behalf to the institution at which I’m enrolling, if that institution saves them after I matriculate.Required Signature _______________________________________________________________________________________ Date _________________© 2011 The Common Application, Inc.SR-2/2011-12Evaluation Please provide comments that will help us differentiate this student from others. Feel free to attach an additional sheet or another reference you have prepared for this student. Alternatively, you may attach a reference written by another school ofcial who can better describe the student. We especially welcome a broad-based assessment and encourage you to consider describing or addressing:s4HEþÿ APPLICANTSþÿ ACADEMIC þÿ EXTRACURRICULAR þÿ ANDþÿ PERSONALþÿ CHARACTERISTICSs2ELEVANTþÿ CONTEXTþÿ FORþÿ THEþÿ APPLICANTSþÿ PERFORMANCEþÿ ANDþÿ INVOLVEMENT þÿ SUCHþÿ ASþÿ PARTICULARITIESþÿ OFþÿ FAMILYþÿ SITUATIONþÿ ORþÿ RESPONSIBILITIES þÿ AFTER SCHOOLþÿ WORKþÿ OBLIGATIONS þÿ SIBLINGþÿ CHILDCARE þÿ or other circumstances, either positive or negative.s/BSERVEDþÿ PROBLEMATICþÿ BEHAVIORS þÿ PERHAPSþÿ SEPARABLEþÿ FROMþÿ ACADEMICþÿ PERFORMANCE þÿ THATþÿ ANþÿ ADMISSIONþÿ COMMITTEEþÿ SHOULDþÿ EXPLOREþÿ FURTHERRatings Compared to other students in his or her class year, how do you rate this student in terms of:þÿ Has the applicant ever been found responsible for a disciplinary violation at your school from the 9th grade (or the international equivalent) forward, whether related to academic misconduct or behavioral misconduct, that resulted in a disciplinary action? These actions could include, but are not limited to: probation, suspension, removal, dismissal, or expulsion from your institution.  Yes  No  School policy prevents me from responding þÿ To your knowledge, has the applicant ever been adjudicated 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 condential 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 basis  With reservation  Fairly strongly  Strongly  EnthusiasticallyBackground Information No basisBelow averageAverageGood (above average)þÿVVery good (well above average)Excellent (top 10%)Outstanding (top 5%)One of the top few I’ve encoun-tered (top 1%)Academic achievementExtracurricular accomplishmentsPersonal qualities and characterOVþÿerallERALLHow long have you known this student and in what context? _________________________________________________________________________________What are the rst words that come to your mind to describe this student? ______________________________________________________________________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: AP _________ IB _________ Honors _________Is the applicant an IB Diploma candidate?  Yes  NoAre classes taken on a block schedule?  Yes  NoIn comparison with other college preparatory students at your school, the applicant’s course selection is: most demanding  very demanding  demanding  average  below averageClass Rank ___________ Class Size ___________ Covering a period from __________ to __________.þÿ (mm/yyyy)þÿ (mm/yyyy)The rank is  weighted  unweighted. 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 ____________þÿ (mm/yyyy) (mm/yyyy)This GPA is  weighted  unweighted. The school’s passing mark is ________________________________.Highest GPA in class ____________________________________ Graduation Date ___________________þÿ (mm/dd/yyyy)Percentage of graduating class immediately attending: ___________four-year ________ two-year institutions©2011 The Common Application, Inc.OR-1/2011-122011-12 OPTIONAL GRADE ReportFor Spring 2012 or Fall 2012 EnrollmentTOTHE APPLICANTThe Optional Grade Report may be used at any point in the academic year to submit updated grades to your colleges and universities, but it should not be used as a substitute for the Midyear or Final Report. After 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.Legal Name ___________________________________________________________________________________________________________________Last/Family/Sur (Enter name exactly as it appears on official documents.)First/Given Middle (complete)Jr., etc.Birth Date ___________________________________________________ CAID (Common App ID)_______________________________________________mm/dd/yyyyAddress ________________________________________________________________________________________________________________________Number & Street Apartment #City/TownState/ProvinceCountryZIP/Postal CodeSchool you now attend ________________________________________________________CEEB/ACT Code _____________________________________Counselors Name (Mr./Mrs./Ms./Dr.) ________________________________________________________________________________________________Please print or typeSignature _________________________________________________________________________________________________ Date _____________________mm/dd/yyyyTitle ___________________________________________________________School _______________________________________________________School Address ________________________________________________________________________________________________________________Number & Street City/TownState/ProvinceCountryZIP/Postal CodeSchool Website Address _________________________________________________________________________________________________________Counselors Telephone (_______) ________________________________________ Counselors Fax (_______) _________________________________________Area/Country/City CodeNumberExt.Area/Country/City Code NumberSchool CEEB/ACT Code ____________________________________ Counselors E-mail _________________________________________________________TOTHE SCHOOL COUNSELORThis form is not a substitute for the Midyear or Final Report. Please use this form only if you wish to update the applicants grades at another point in the year. Attach the applicants of“cial transcript, including courses in progress and transcript legend. (Please check transcript copies for readability.) Be sure to sign below before mailing directly to the college/university admission of“ce. Do not mail this form to The Common Application of“ces. Female MaleORIMPORTANT PRIVACY NOTE: In accordance with the Family Educational Rights and Privacy Act (FERPA), the original School Report submitted on your behalf re”ects your choice to waive or not waive your right of access to all recommendations and supporting documents. That response applies to all subsequent reports, 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 recommendations submitted by me or on my behalf.No, I do not waive my right to access, and I may someday choose to see this form or any other recommendations or supporting documents submitted by me or on my behalf to the institution at which Im enrolling, if that institution saves them after I matriculate.Background Information If any of the information below has changed for this student since the School Report was submitted, please enter the new information in the appropriate section below. Class Rank _______ Class Size ______ Covering a period from _______ to ______.(mm/yyyy)(mm/yyyy)The rank is weighted  unweighted. How many additional students share this rank?__________ We do not rank. Instead, please indicate quartile ____ quintile ____ decile ______Cumulative GPA: _____ on a _____ scale, covering a period from _______ to ______.(mm/yyyy)(mm/yyyy)This GPA is  weighted  unweighted. The schools passing mark is _____________.Highest GPA in class _____________________ Graduation Date ________________(mm/dd/yyyy)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 applicants disciplinary status at your school since you submitted the original School Report? Yes  No School policy prevents me from respondingTo your knowledge, have there been any changes to the applicants criminal history since you submitted the original School Report? Yes  No School policy prevents me from respondingDo you wish to update your original evaluation of this applicant?  Yes  No 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-1/2011-122011-12 MIDYEAR ReportFor Spring 2012 or Fall 2012 EnrollmentTO þÿtTHþÿeE þÿapplicantAPPLICANTAfter completing the information in this section, give this form to your school counselor or another school ofcial who knows you better. If applying via mail, please also give that school ofcial stamped envelopes addressed to each institution to which you have applied.Legal Name ___________________________________________________________________________________________________________________þÿ Last/Family/Sur (Enter name exactly as it appears on official documents.)þÿ First/Given þÿ Middle (complete)þÿ Jr., etc.Birth Date ___________________________________________________þÿ mm/dd/yyyyAddress ________________________________________________________________________________________________________________________þÿ Number & Street Apartment #þÿ City/Townþÿ State/Provinceþÿ Countryþÿ ZIP/Postal CodeSchool you now attend ________________________________________________________þÿ CEEB/ACT Code _____________________________________Counselor’s Name (Mr./Mrs./Ms./Dr.) þÿ_ ________________________________________________________________________________________________þÿ Please print or typeSignature _________________________________________________________________________________________________ Date _____________________þÿ mm/dd/yyyyTitle ___________________________________________________________þÿ School _______________________________________________________School Address þÿ_ ________________________________________________________________________________________________________________þÿ Number & Street þÿ City/Townþÿ State/Provinceþÿ Countryþÿ ZIP/Postal CodeSchool Website Address þÿ_ _________________________________________________________________________________________________________Counselor’s Telephone (_______) ________________________________________ Counselor’s Fax (_______) _________________________________________þÿ Area/Country/City Codeþÿ Numberþÿ Ext.þÿ Area/Country/City Code þÿ NumberSchool CEEB/ACT Code ____________________________________ Counselor’s E-mail _________________________________________________________TO þÿtTHþÿeE SCþÿHOOHOOL CþÿOOUNSELþÿOORPlease submit this form when midyear grades are available (end of rst semester or second trimester). Attach applicant’s ofcial transcript, including courses in progress and transcript legend. (Please check transcript copies for readability.) Be sure to sign below before mailing directly to the college/university admission ofce. Do not mail this form to The Common Application ofces. Female  MaleMRIMPORTANT PRIþÿVVACY NOTE: In accordance with the Family Educational Rights and Privacy Act (FERPA), the original School Report submitted on your behalf reects your choice to waive or not waive your right of access to all recommendations and supporting documents. That response applies to all subsequent reports, including this one.Background Information If any of the information below has changed for this student since the School Report was submitted, please enter the new information in the appropriate section below. Class Rank _______ Class Size ______ Covering a period from _______ to ______.þÿ (mm/yyyy)þÿ (mm/yyyy)The rank is  weighted  unweighted. How many additional students share this rank?__________ We do not rank. Instead, please indicate quartile ____ quintile ____ decile ______Cumulative GPA: _____ on a _____ scale, covering a period from _______ to ______.þÿ (mm/yyyy)þÿ (mm/yyyy)This GPA is  weighted  unweighted. The school’s passing mark is _____________.Highest GPA in class _____________________ Graduation Date ________________þÿ (mm/dd/yyyy)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 applicant’s disciplinary status at your school since you submitted the original School Report?  Yes  No  School policy prevents me from respondingTo your knowledge, have their been any changes to the applicant’s criminal history since you submitted the original School Report?  Yes  No  School policy prevents me from respondingDo you wish to update your original evaluation of this applicant?  Yes  No 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.2011-12 nal ReportFor Spring 2012 or Fall 2012 EnrollmentTO þÿtTHþÿeE þÿapplicantAPPLICANTAfter completing the information in this section, give this form to your school counselor or another school ofcial who knows you better. If applying via mail, please also give that school ofcial stamped envelopes addressed to all institutions requesting a nal transcript. Legal Name ___________________________________________________________________________________________________________________þÿ Last/Family/Sur (Enter name exactly as it appears on official documents.)þÿ First/Given þÿ Middle (complete)þÿ Jr., etc.Birth Date ___________________________________________________þÿ mm/dd/yyyyAddress ________________________________________________________________________________________________________________________þÿ Number & Street Apartment #þÿ City/Townþÿ State/Provinceþÿ Countryþÿ ZIP/Postal CodeSchool you now attend ________________________________________________________þÿ CEEB/ACT Code _____________________________________Counselor’s Name (Mr./Mrs./Ms./Dr.) þÿ_ ________________________________________________________________________________________________þÿ Please print or typeSignature _________________________________________________________________________________________________ Date _____________________þÿ mm/dd/yyyyTitle ___________________________________________________________þÿ School _______________________________________________________School Address þÿ_ ________________________________________________________________________________________________________________þÿ Number & Street þÿ City/Townþÿ State/Provinceþÿ Countryþÿ ZIP/Postal CodeSchool Website Address þÿ_ _________________________________________________________________________________________________________Counselor’s Telephone (_______) ________________________________________ Counselor’s Fax (_______) _________________________________________þÿ Area/Country/City Codeþÿ Numberþÿ Ext.þÿ Area/Country/City Code þÿ NumberSchool CEEB/ACT Code __________________________________ Counselor’s E-mail __________________________________________________________TO þÿtTHþÿeE SCþÿHOOHOOL CþÿOOUNSELþÿOORPlease submit this form when nal grades are available (end of second semester or third trimester). Attach applicant’s ofcial transcript and transcript legend. (Please check transcript copies for readability.) Be sure to sign below before mailing directly to the college/university admission ofce. Do not mail this form to The Common Application ofces. Female  MaleFRIMPORTANT PRIþÿVVACY NOTE: In accordance with the Family Educational Rights and Privacy Act (FERPA), the original School Report submitted on your behalf reects your choice to waive or not waive your right of access to all recommendations and supporting documents. That response applies to all subsequent reports, including this one.Background Information If any of the information below has changed for this student since the Midyear Report was submitted, please enter the new information in the appropriate section below. 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 applicant’s disciplinary status at your school since you submitted the original School Report?  Yes  No  School policy prevents me from respondingTo your knowledge, have their been any changes to the applicant’s criminal history since you submitted the original School Report?  Yes  No  School policy prevents me from respondingDo you wish to update your original evaluation of this applicant?  Yes  No 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.Class Rank _______ Class Size ______ Covering a period from _______ to ______.þÿ (mm/yyyy)þÿ (mm/yyyy)The rank is  weighted  unweighted. How many additional students share this rank?__________ We do not rank. Instead, please indicate quartile ____ quintile ____ decile ______Cumulative GPA: _____ on a _____ scale, covering a period from _______ to ______.þÿ (mm/yyyy)þÿ (mm/yyyy)This GPA is  weighted  unweighted. The school’s passing mark is _____________.Highest GPA in class _____________________ Graduation Date ________________þÿ (mm/dd/yyyy)FR-1/2011-12