©
2016 The Common Application, Inc.
CR
COLLEGE Report
To The applicanT
This form must accompany an official copy of your transcript and must be completed by a college official(s) who has access to your academic record
and your disciplinary record. Please follow these steps to ensure the form is completed accurately and in its entirety. Step 1: Complete all relevant questions
below, including the signature statement. Step 2: Give this form to a dean or college official who has access to your academic record and ask that official to com-
plete the academic portion of this form. Step 3: If the official completing the academic portion does not also have access to your disciplinary record, please ask the
individual to securely forward the form to a second official who can answer those questions before duplicating this form and mailing it to your colleges along with
copies of your official transcript(s).
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/university you now attend ________________________________________________ CEEB/ACT Code ______________________________________
Current year courses—please indicate title, level, and credit value of all courses you are taking this year. Indicate quarter classes taken in the same semester on the
appropriate semester line.
First Semester/Quarter Grade Second Semester/Quarter Grade Third Quarter Grade
________________________________________ ________________________________________ _________________________________________
________________________________________ ________________________________________ _________________________________________
________________________________________ ________________________________________ _________________________________________
________________________________________ ________________________________________ _________________________________________
________________________________________ ________________________________________ _________________________________________
How many college credits have you earned prior to this academic year? ________ How many college credits will you earn this academic year? ________
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 _________________
To The colleGe oFFicial
If you have access to the applicant’s academic record and disciplinary record, please complete this form in its entirety. Attach the applicant’s official transcript (check
copies for readability). Use both pages to complete your evaluation for this student, and be sure to sign below. If you have access to the applicant’s academic record only,
please complete the relevant portion of this form, then forward to the appropriate official for completion of the disciplinary questions, asking that official to mail the form
to the applicant’s colleges after doing so. Do not mail this form to The Common Application offices.
College Official’s Name (Mr./Mrs./Ms./Dr.) _____________________________________________________________________________________________
Please print or type
Signature _________________________________________________________________________________________________ Date _____________________
mm/dd/yyyy
Title ___________________________________________________________ College or University _____________________________________________
College or University Address ______________________________________________________________________________________________________
City/Town State/Province Country ZIP/Postal Code
College Official’s Telephone (_______) ___________________________________ College Official’s Fax (_______) _____________________________________
Area/Country/City Code Number Ext. Area/Country/City Code Number Ext.
College or University CEEB/ACT Code ___________________________ College Official’s E-mail ___________________________________________________
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