STUDENT RESPONSE FORM. - Concord

CONCORD-CARLISLE HIGH SCHOOL
STUDENT RESPONSE FORM
Name of Student:
Address:
Home Phone: (
)
Email:
Citizenship:
If not a U.S. citizen, what visa do you hold?
Primary language spoken at home:
Other languages spoken at home:
Will you be the first in your immediate family to go to college?
School(s) attended prior to Concord-Carlisle:
Name
Location
Grades (or Dates)
Parent/Guardian 1: Name:
First
Middle
! Yes
Lives with you at home:
Last
! No
Occupation:
Name of business or organization:
College(s) attended:
Name
Year
Degree
First
Middle
Last
Parent/Guardian 2: Name:
! Yes
Lives with you at home:
! No
Occupation:
Name of business or organization:
College(s) attended:
Name
Siblings:
First Name
Age
School/Colleges Attended
Year
Degree
Occupation
Lives with
you at home
! Yes ! No
! Yes ! No
! Yes ! No
COUNSELOR’S SENIOR INFORMATION SHEET
Name:
email:
Date:
To assist me in representing you as accurately as possible when writing your recommendation, please answer
the following questions. Please also provide me with a listing of your activities, awards, jobs, etc.
1. Why do you want to go to college? Be honest.
2. At this time, what personal, educational, or vocational goals do you have in mind? What areas of study
might you like to pursue in college? Do you have any clear ideas about what you hope to do after
graduation from college? Where do you see yourself in ten years?
3. What has been you most rewarding experience (academic accomplishment, cause, project) in the past few
years? Why?
4. As a student, I feel my strengths are:
My weaknesses are:
5. What courses have you enjoyed the most over the last few years? Why?
6. Give five adjectives that tell something about you as a person.
7. What extracurricular activity has been most important to you? Why?
8. Have you pursued any activities outside of school (evenings, weekends, summers) that you consider
important? Please explain.
9. How have you spent the last two summers? What are your plans for this summer? Include any jobs you
have held.
10. Of what accomplishments are you most proud? Why?
11. Are there any outside circumstances that have interfered with your academic performance? Is there
anything on your transcript that you feel warrants clarification?
12. What two CCHS teachers know you the best?
13. Do you have a learning disability that has warranted special accommodations? If so, do we have your
permission to discuss it in the school letter as a way of providing context for your academic performance?
(We should definitely talk about this during your college meeting).
14. What would like me to say about you in my letter of recommendation?
15. Is there anything else that you would like to share with me that you feel would be helpful in my writing
your letter.
ACTIVITY WORKSHEET:
NAME:
Feel free to attach additional information on any category, if needed. Indicate appropriate code(s) for each year you have participated in a sport at
CCHS or without the community.
FR = freshmen
V = varsity
JV = junior varsity
SPORT
GRADE 9
GRADE 10
Baseball
Basketball
Cheerleading
Cross Country
Fencing
Field Hockey
Football
Golf
Ice Hockey
Indoor Track
Intramural
Lacrosse
Outdoor Track
Skiing
Soccer
Softball
Swimming & Diving
Tennis
Volleyball
Wrestling
Town League(s)
X = Member
P = President
ACTIVITY/CLUB
Academic Bowl Team
Amnesty International
Art Club
BookPALS
Bull Market
CC Weather Services
Chicken Scratch
Christian Club
Class Officer
Dance Club
Environmental Club
Environmental Field Studies Club
Film Club
Girls’ Social Forum
History Reading Club
Improv Comedy Club
Interact Club
Junior State
Magic Club
Math Team
METCO Student Leadership Comm.
Model UN
Moot Court
Multi Cultural Club
National Honor Society
Outdoor Club
Paintball Club
Pep Band
Robotics Club
S.A.D.D.
Sci-Fi Club
Science Olympiad
Serious Repercussions Club
Spectrum
Sports Forum
Step Club
Student Senate
T.O.Y.S (Teach Our Youth Science)
Teen Buddy
Theatre Tech Crew
Third Wing
Ultimate Frisbee
Urban Art Club
W.E.E.D.s (Organic Garden Club)
Yoga Club
Other
C = captain
GRADE 11
VP = Vice President
GRADE 9
CODES
CO-C = co-captain
GRADE 12
M = manager
POSITION/SPECIALTY
Sport:
CODES
S = Secretary
GRADE 10
T = Treasurer
GRADE 11
GRADE 12
Please provide additional information for the following Co-Curricular Activities:
Include the year of participation and all pertinent information.
Band (Instrument played, group(s) performed with during the year, etc.) Dramatics (Name of production, role, etc.) Literary Arts Magazine (Type of work performed) Musical (Name of production, role, etc.) Newspaper (Type of work performed) Radio Station (Type of work performed) Yearbook (Type of work performed) –
WORKSHEET EXPERIENCE
INDICATE APPROPRIATE INFORMATION FOR EACH YEAR YOU HAVE WORKED:
Grade
Place Worked
Hours/Dates Worked
Duties
9th
Summer
10th
Summer
11th
Summer
12th
Please feel free to attach additional information, if necessary.
AWARD/HONORS
INDICATE ANY AWARD/HONORS RECEIVED IN EACH YEAR OF HIGH SCHOOL:
Grade
Name of Honor/Award
(academic, athletic, community, etc.)
Type of Award/Further Explanation
9th
10th
11th
12th
Please feel free to attach additional information, if necessary.
VOLUNTEER ACTIVITIES:
Describe volunteer activities you have performed during your high school years. Be sure to include when the service was performed, where it took
place, and the nature of the work performed.
PARENT TO COUNSELOR INFORMATION SHEET
We invite you to provide information to your child’s guidance counselor that may be helpful to the counselor.
The student may return the form to the counselor, or you may mail it to the counselor at 500 Walden St.,
Concord, MA 01742. Please feel free to use e-mail if more convenient. Counselor e-mail addresses are
available in the high school website.
Student Name:
Parent Name:
1. What do you consider the outstanding accomplishments of your child during the past three or four years?
Why did you select these as most important?
2. In what areas has your child shown most development and growth during the past three or four years?
3. If you had to describe your child in five adjectives, what would they be? Why would you choose those
adjectives? Please be specific.
4. Are there any unusual or difficult circumstances (learning issues, family history, etc.) which have affected
your child’s educational experiences?
5. Please feel free to make any additional comments about your child or concerns you may have about the
college process (financial, personal, etc.) below or on the back of the paper.
6. Do we have your permission to discuss the information you have provided here in the school letter written
on behalf of your son/daughter? Yes
No
_______________________________
Parent Signature