Secondary School Report Form printable pdf download

Secondary School Report Form

Instructions: Students should complete Section I and submit the form to their school counselor. Counselors should

complete Sections II and III and forward the report form along with the respective admission application to each school to

which the student is applying.

SECTION I

(to be completed by student)

*Optional

Student Name _____________________________________________________________________________________

Address __________________________________________________________________________________________

Street

City

State

Zip

Date of Birth*_____________________________________

SSN*___________________________________________

Email ____________________________________________ Phone _________________________________________

I am applying for:  Early Decision

 Early Action

 Regular Decision

 Other _________________________

I recognize the confidential nature of this document and I  do  don’t waive my right to access.

Student’s Signature _________________________________________ Date _________________________________

SENIOR YEAR COURSES

(if not included on transcript):

First Term:

Second term:

Course

Grade

Course

Grade

_____________________________________ ______

_____________________________________ _______

_____________________________________ ______

_____________________________________ _______

_____________________________________ ______

_____________________________________ _______

_____________________________________ ______

_____________________________________ _______

_____________________________________ ______

_____________________________________ _______

SECTION II

(to be completed by school counselor—include information only if not included in other student documents)

High School _____________________________________________ High School CEEB _________________________

Address __________________________________________________________________________________________

Street

City

State

Zip

Phone __________________________________________________ Fax _____________________________________

Counselor’s Name ________________________________________ Title _____________________________________

Percentage of class attending: Four-Year __________ Two-Year ________ institutions.

Grading scale:  4.0

 100  other _____________________

Passing Grade is _____________

Student’s GPA:  Weighted  Unweighted

GPA includes (check all that apply):  9

 10

 11

 12

Grade

Student ranks _____ in a class of _____ as of:  9

Grade  10

Grade  11

Grade  12

Grade

 We do not rank

Is the student’s course selection:  Most Demanding

 Demanding

 Average

 Below Average

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Secondary School Report Form

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