©
2016 The Common Application, Inc. | Property of The Common Application, Inc.
IE-1
TO THE APPLICANT
After completing all the relevant questions below, give this form to an instructor who has taught you a full-credit college class. If applying via mail, please also give
that instructor stamped envelopes addressed to each institution that requires a Academic Evaluation.
Legal Name ___________________________________________________________________________________________________________________
Last/Family/Sur (Enter name exactly as it appears on official documents.) First/Given Middle (complete) Jr., etc.
Birth Date ___________________________________________________ CAID (Common App ID) _______________________________________________
mm/dd/yyyy
Address ________________________________________________________________________________________________________________________
Number & Street Apartment # City/Town County or Parish State/Province Country ZIP/Postal Code
College or university you now attend ______________________________________________ CEEB/ACT Code ______________________________________
INSTRUCTOR EVALUATION 1
TO THE INSTRUCTOR
The Common Application membership finds candid evaluations helpful in choosing from among highly qualified candidates. You are encouraged to keep this form
in your private files for use should the student need additional recommendations. Please submit your references promptly, and remember to sign below before
mailing directly to the college/university admission office. Do not mail this form to The Common Application offices.
Instructor’s Name (Mr./Mrs./Ms./Dr.) _______________________________________________________ Subject Taught _______________________________
Please print or type
Signature _________________________________________________________________________________________________ Date _____________________
mm/dd/yyyy
College or University _____________________________________________________________________________________________________________
School Address ________________________________________________________________________________________________________________
Number & Street City/Town State/Province Country ZIP/Postal Code
Instructor’s Telephone (_______) ________________________________________________ Instructor’s E-mail ____________________________________
Area/Country/City Code Number Ext.
Background Information
How long have you known this student and in what context? _______________________________________________________________________________
What are the first words that come to your mind to describe this student?
_____________________________________________________________________
List the courses you have taught this student, noting for each the student’s year in school (first-year, sophomore, etc.) and the level of course difficulty
(100-level, 200-level, etc.).
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
ACADEMIC EVALUATION
IMPORTANT PRIVACY NOTICE: By signing this form, I authorize every school that I have attended to release all requested records and recommendations to
colleges to which I am applying for admission. I also authorize employees at these colleges to confidentially contact my current and former schools should they
have questions about the information submitted on my behalf.
p I waive my right to review all recommendations and supporting documents submitted by me or on my behalf.
p I DO NOT waive my right to review all recommendations and supporting documents submitted by me or on my behalf.
• I have chosen not to waive my right to review my recommendations and supporting documents. I understand that my decision may lead my
counselors or teachers to decline to write recommendations on my behalf. I also understand that my decision may lead colleges to disregard
any recommendations submitted on my behalf.
I understand that my waiver or no waiver selection above pertains to all colleges to which I apply and that my selections cannot be changed after any
recommendation or application submission.
Required Signature _____________________________________________________________________________________ Date _________________
