PERSONAL DATA FORM
It is important that this form be filled out completely and accurately to aid teachers and others in
preparing recommendations for your use with applications for colleges and scholarships.
Requests for Letters of Recommendation should be submitted at least two weeks in advance
of the due date.
Please provide the following contact information:
Name:
Street Address: City: Zip:
Home Phone: Email:
College Plans (Where will you apply;
What is your intended major)
Future/Career Plans, related experience
Special interests, hobbies, talents
Five words you would use to describe
yourself
Travel Experiences
Additional information, including
Courses taken at DVC, through ROP, etc.
Awards and Honors
References: Three teachers or staff
members who know you well
**Please attach your college essay, even if it is still in "draft" form.
EXTRA CURRICULAR ACTIVITIES
School Activities
ACTIVITY
9
10
12
HRS/WK
WK/YR
POSITIONS HELD, LETTERS EARNED, HONORS WON
Outside Activities
ACTIVITY
9
10
11
12
HRS/WK
WK/YR
POSITIONS HELD, LETTERS EARNED, HONORS WON
ETS Activities
ACTIVITY
9
10
11
12
HRS/WK
WK/YR
POSITIONS HELD, LETTERS EARNED, HONORS WON
EMPLOYMENT/COMMUNITY SERVICE
SPECIFIC NATURE OF WORK
EMPLOYER
DATES OF EMPLOYMENT
HOURS PER WEEK
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Revised 2/6/2012