Date Received By Counselor: ______(to be filled out by Ms. Prosowski ONLY)

Earliest Deadline Date (as confirmed by the Registrar's Office): ______

Stacy Prosowski

Guidance Counselor - Lexington High School

781.861.2320 x1567,

Student's Full Name: ______

Telephone # & E-Mail Address: ______

This completed questionnaire will provide information to assist in writing the school's statement.

Please read and follow the directions carefully:

- Answer the following questions in the space provided or retype on a separate sheet of paper.

- Word processing is preferred. If you do not have access to a computer, please print legibly.

- Give to your counselor at least two to three weeks prior to your earliest application deadline date.

- Pay attention to your own application deadlines. Stay organized.

NOTE: Remember to complete a Transcript Request (via Family Connection) at least two weeks prior to your earliest application deadline date(s). Please see me or the Registrar if you have any questions. Paper Transcript Request Forms are available upon request in the Registrar's Office (Room #152). THANK YOU.

Please list four adjectives which you, your family or friends would use to best describe you. Include anecdotes or examples. ______

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Do you speak any language(s) other than English at home (with fluency)? If so, what language(s)?

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Will you be applying to a college that your parents or grandparents attended? If so, where? ______

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Which of your personal attributes and academic qualities do you feel are important to bring to the attention of a college Admissions Committee or a person writing a recommendation for you? Who are you? (List & Describe).

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What are your greatest strengths (both academic & personal)? ______

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What do you feel need to improve upon? ______

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Have there been any particular experience(s) or incident(s) that have had a major impact on you, your goals, or values? Explain. ______

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Do you receive any Special Education Services (resource, extended time on tests or SAT's)? If YES, please explain. Do you grant me permission to include this information in my statement? YES NO (Initial): ______

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Do you believe your transcript is an accurate reflection of your abilities & potentials? If YES, please explain. If not, what do you consider the best measure of your potential for success in college work? Describe.

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What circumstances, if any, have interfered with your academic or social performance at LHS? [i.e.: moving, cultural differences, accident, divorce, death, difficult home situations, or health problems] ______

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What courses are you most enthusiastic about? Are you academically skilled in some areas rather than others (verbal vs. math/science)? ______

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Which course(s) gave you the most difficulty and how did you handle the challenge?

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What specific course(s) would you like to investigate or major in at college? Why?

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Have you had any experiences which informed and influenced this idea? Explain.

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What are your educational and career goals? Describe.

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What do you choose to learn on your own? Please consider interests pursued beyond class assignments. What do your choices show about your interests and the way you like to learn?

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Do you have any special talents or hobbies? Have you taken any courses or lessons outside of school? If yes, list and describe. ______

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If you have completed an "ACTIVITIES RESUME" please attach it and skip the next question.

List and describe any awards or honors-both academic and/or non-academic. List and describe any leadership roles you have (school and community). ______

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Is there anything else you want to share with me so that I can write an accurate appraisal of you in your counselor statement? Or, just tell me something you think I should know that's not covered in any of these questions. Also, is there anything you feel I should omit from the counselor statement?

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THANK YOU.

(revised June, 2005 - LRE)

Stacy Prosowski

781.861.2320 x1567

OPTIONAL GUARDIAN'S QUESTIONNAIRE FORM

(Recommended but not required)

Writer's Name & Relationship:______

Student's Name:______

Please answer the following questions either in the space provided or on a separate sheet of paper (type or print). Thank you.

1. What do you consider to be your son/daughter's most outstanding accomplishments over the past three to four years?

2. In what areas has your son/daughter shown the most development and growth during the past three to four years?

3. What do you consider to be his/her outstanding personality traits?

4. Are there any particular interests, projects, talents, or hobbies you might see that we are not aware of here?

5. Has your son/daughter faced any personal challenges or difficult experiences which may have affected his/her academic or emotional growth?

6. Has your son or daughter ever received any Special Education Services? Is there an active Individual Educational Plan on file at LHS? If so, do you grant me permission to include this information in my statement?

7. Is there anything else that you would like me to share in my school statement? Any anecdotes that reflect your son/daughter's uniqueness and/or personality?

8. Is it okay for the counselor to quote from your above-mentioned statements?YESNO

Please return to the counselor at least two to three weeks prior to the earliest deadline.

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