Rate the applicant in respect to the following eight variables. Place a check mark in the one box that best characterizes
your assessment for each trait.
One of the
of this trait
People I have
Positive Self Concept
Student demonstrates self-awareness, strength
of character, determination, and independence.
Realistic Self Appraisal
Student demonstrates the ability to recognize
her/his strengths and deficiencies, and works
hard at self-development.
Long-Term Goal Setting and Follow-Through
Student demonstrates the ability to plan ahead,
set goals, and work toward these goals though
gratification may have to be deferred.
Navigating Social Systems
Student demonstrates an awareness of how
her/his social system works, and how s/he can
get things done even if s/he is at a disad-
vantage because the system has been designed
by others. Despite any challenges, the student
acts positively, effectively, and assertively to
Willingness to Use Support Systems
Student demonstrates the ability and willing-
ness to turn to a mentor or other strong sup-
port person for encouragement in a crisis.
Student demonstrates an awareness of the
world beyond her/his needs through participa-
tion in community involvement projects, or
assists in meeting her/his own family needs.
Student demonstrates positive leadership in
some area of her/his life (e.g. family, work,
religious, sports, community, academic, or non-
Student possesses a zeal for learning that is
demonstrated in her/his development of an
interest area outside the regular curriculum —
perhaps concerning her/his cultural background
or involving culturally derived ways of learning.
College Success Foundation • 1605 NW Sammamish Road, Suite 200 • Issaquah, WA 98027
Ph. 425.416.2000 • Fx. 425.416.2001 • Toll free 877.655.4097 •