Secondary School Report
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3Secondary School Report
INSTRUCTIONS: Counselors, please verify that the For the Student section is complete (if it is not, ask the student to provide the
missing information), fill out the For the Counselor section and forward this form, along with other supporting/attached documents,
to either individual or multiple schools to which this student is applying.
FOR THE STUDENT
Student Name
/
/
Address
Date of Birth (mm/dd/yyyy)
City
State/Province
ZIP/Postal Code
(
)
–
Country
Phone
Email
I am applying for:
Early Decision
Early Action
Regular Decision
Other
Important Privacy Note: By signing this form, I authorize all schools I have attended to release all requested records covered under the Federal
Educational Rights and Privacy Act (FERPA) so that my application may be reviewed by the institution(s) to which I am applying. I further authorize
the admission officers reviewing my application, including seasonal staff employed for the sole purpose of evaluating applications, to contact officials
at my current and former schools should they have questions about the school forms submitted on my behalf.
I waive my right to review or access letters and statements of recommendation on my behalf.
Yes
No
Required Signature
Date
FOR THE COUNSELOR
High School
High School CEEB
Address
City
State/Province
ZIP/Postal Code
Phone
Fax
Counselor’s Name
Title
Email
Percentage of class attending:
Four-Year
Two-Year
institutions.
Grading Scale
4.0
100
Other
Passing Grade
Student’s GPA
Weighted
Unweighted
GPA includes (check all that apply):
9th Grade
10th Grade
11th Grade
12th Grade
Student rank
in a class of
as of:
9th Grade
10th Grade
11th Grade
12th Grade
We do not rank
This student’s course selection is:
Most Demanding
Very Demanding
Demanding
Average
Below Average
Type and number of courses offered at your school:
AP
IB
Honors
Maximum number a student may take in a given year, if limited:
AP
IB
Honors
Applicant is an IB Diploma candidate:
Yes
No
Classes are taken on a block schedule:
Yes
No
Please list the applicant’s senior-year courses indicating term/marking period (include course level – AP, honors, IB, etc.).
V3
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