STUDENT INFORMATION FORM 2017-2018
for Counselor Letter of Recommendation from Mr. Jones
Directions to the Student: This form must be typed. Your answers need to be detailed but not wordy. As the purpose of this packet is to give me useful, complete information that I can send to your colleges, it’s in your best interest to do this task well. I may be quoting from your answers when I write your counselor letters, so write thoughtfully. When it is complete, you must save the document with YOUR name in the file name and email it to me at . Your completed assignment must be in my inbox on or before August 6 , 2016, and will count for 100 points in your English grade (for me or for Mrs. Smith).
1. Last name: First Name:
2. Name you prefer to be called: Today’s date:
3. Your phone: Email:
4. Father’s name: Father’s occupation:
Father’s phone: Father’s email:
5. Mother’s name: Mother’s occupation:
Mother’s phone: Mother’s email:
6. Will you be the first person in your family to attend college?
7. Primary Language spoken at home : Your ethnicity:
QUICKIE QUESTIONS: Answer in about 40 words each
*What do you read for fun?
*Name three things you can’t live without.
*What are your hobbies/interests?
*What is your favorite academic subject? Why?
*What is a special talent or interest that you think would be most interesting to colleges?
SHORT ANSWER QUESTIONS ( Max: 200 words each )
1. SCHOOL ACTIVITIES: Which school activity/club/sport has been most meaningful for you during your years at CHS? Why?
2. COMMUNITY ACTIVITIES: Describe something you’re proud of having accomplished in an
outside-of-school activity (music/organizations/dance, etc.) and why it is significant to you.
3. EXPERIENCES: Describe the community service, travel, or work experience that has meant the most to you & why.
4. FUTURE PLANS: Where do you see yourself in ten years? Career? Location? Why?
5. GRADES AND TEST SCORES: Do you think your grades/GPA and standardized test scores are a good indication of who you are as a student? Why or why not? If not, why is there a discrepancy?
6. LEADER OR TEAM PLAYER: Would you describe yourself as a leader or as a team player? (Or both?) Give an example of a time when you proved either your leadership skills or your ability to work as part of a larger group toward a common goal.
7. LESSON LEARNED: Briefly describe a time when you did not achieve a goal or suffered a setback that shook your determination a bit. How did you recover? How did it change you for the better?
8. THE “X” FACTOR: What do you wish you could tell colleges that you don’t think you’ll be able to work into your application? Something fun, something serious, something important—anything that you think helps create a fuller picture of you for college admissions officers.
9. IB LEARNER PROFILE: The characteristics listed below are used to describe IB learners. Choose the TWO characteristics that best describe you as a learner. For each, give a SPECIFIC example or anecdote that shows how you have demonstrated this quality.
· Inquirer: Curious & independent learner who loves learning
· Knowledgeable: Explores concepts, seeking in-depth knowledge
· Thinker: Approaches complex problems critically & creatively
· Communicator: Expresses ideas confidently & creatively
· Principled: Acts with honesty & integrity; takes responsibility for actions
· Open-minded: Open to perspectives & values of others
· Caring: Shows empathy & compassion; personal commitment to service
· Risk-taker: Approaches unfamiliar situations with courage & independence of spirit
· Balanced: Understands importance of intellectual, physical & emotional balance
· Reflective: Gives thoughtful consideration to his/her learning & experience
a. Characteristic & example:
b. Characteristic & example:
10. FAMILY: Briefly describe your family—who you live with, your heritage, what you do together, etc.
11. ADVERSITY: Explain any situations that have required you to overcome adversity or obstacles. How did you deal with the situation? Did you become stronger? How?
12. EXTENDED ESSAY: What is your Extended Essay topic? Why is this topic of interest to you?
13. CAS: What are the major activities you’ve been involved in for your CAS activities ?
14. YOUR HOOK: What is your “hook?” In every stack of college applications, there is one person that is remembered for something unique, interesting, or just funny. “The guy who plays in a jazz band on weekends.” “The girl who ran a marathon when she was twelve years old.” “The one who made it to the semi-finals of American Idol .” What will make you stand out to admissions officers—and isn’t already apparent on your application, transcript or test scores?
15. APPLICATION ESSAY DRAFT: Choose one of the following Common Application topics and write a response of 400-600 words in this document. Failure to complete this part will result in a loss of 50 points from the total grade for this assignment.
1. Some students have a background, identity, interest, or talent that is so meaningful they believe their application would be incomplete without it. If this sounds like you, then please share your story.
2. The lessons we take from obstacles we encounter can be fundamental to later success. Recount a time when you faced a challenge, setback, or failure. How did it affect you, and what did you learn from the experience?
3. Reflect on a time when you questioned or challenged a belief or idea. What prompted your thinking? What was the outcome?
4. Describe a problem you've solved or a problem you'd like to solve. It can be an intellectual challenge, a research query, an ethical dilemma - anything that is of personal importance, no matter the scale. Explain its significance to you and what steps you took or could be taken to identify a solution.
5. Discuss an accomplishment, event, or realization that sparked a period of personal growth and a new understanding of yourself or others.
6. Describe a topic, idea, or concept you find so engaging that it makes you lose all track of time. Why does it captivate you? What or who do you turn to when you want to learn more?
WRITE YOUR RESPONSE BELOW:
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