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After completing all the relevant questions below, give this form to your secondary school counselor or another school official who knows you better. If applying
via mail, please also give that teacher stamped envelopes addressed to each institution that requires a School Report.
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) _______________________________________________
Address ________________________________________________________________________________________________________________________
Number & Street Apartment #
City/Town State/Province Country ZIP/Postal Code
School you now attend CEEB/ACT Code _____________________________________
Current year courses—please indicate title, level (AP, IB, advanced honors, etc.) and credit value of all courses you are taking this year. Indicate quarter
classes taken in the same semester on the appropriate semester line.
Full Year/First Semester/First Trimester Second Semester/Second Trimester Third Trimester
or additional first/second term courses if more space is needed
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.
I waive my right to review all recommendations and supporting documents submitted by me or on my behalf.
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 recommenda
tions 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 _________________
Attach applicant’s official transcript, including courses in progress, a school profile, and transcript legend. (Check transcript copies for readability.) Use
both pages to
complete your evaluation for this student. Be sure to sign below before mailing to the Elizabethtown College admission office. You
may also fax this form to 717-361-1365 or send via email to apply@etown.edu.
Counselor’s Name (Mr./Mrs./Ms./Dr.)
Please print or type
Signature _________________________________________________________________________________________________ Date _____________________
Title School _______________________________________________________
School Address
Number & Street City/Town State/Province Country ZIP/Postal Code
School Website Address _________________________________________________________________________________________________________
Counselor’s Telephone (_______) ________________________________________ Counselor’s Fax (_______) _________________________________________
Area/Country/City Code Number Ext. Area/Country/City Code Number
School CEEB/ACT Code ____________________________ _________________________________________________________________ Counselor’s E-mail
With reservation
The school’s passing mark is
Background Information
Class Rank ___________ Class Size ___________ Covering a period from __________ to __________.
(mm/yyyy) (mm/yyyy)
The rank is p weighted p unweighted. How many additional students share this rank? _________________
How do you report class rank? quartile _____________ quintile _____________ decile ______________
Cumulative GPA: ________ on a _________ scale, covering a period from ____________ to ____________.
(mm/yyyy) (mm/yyyy)
This GPA is p weighted p unweighted. ________________________________.
Highest GPA in class ____________________________________ Graduation Date ___________________
Percentage of graduating class immediately attending: ___________four-year ________ two-year institutions
Does your school require students to perform volunteer service?
p Yes p No
Is the applicant an Advanced Cambridge (AICE) Diploma Candidate?
p Yes p No
Ratings Compared to other students in his or her class year, how do you rate this student in terms of:
How many courses does your school offer:
AP _________ IB _________ Honors _________
If school policy limits the number a student may take in
a given year, please list the maximum allowed:
AP _________ IB _________ Honors _________
Is the applicant an IB Diploma candidate?
p Yes p No
Are classes taken on a block schedule?
p Yes p No
In comparison with other college preparatory students
at your school, the applicant’s course selection is:
p less than demanding
average demanding
very demanding
most demanding
prefer not to respond
One of the top
Very good few I’ve
Below Good (above (well above Excellent Outstanding encountered
No basis average Average average) average) (top 10%) (top 5%) (top 1%)
Academic achievement
Extracurricular accomplishments
Personal qualities and character
Has the applicant ever been found responsible for a disciplinary violation at your school from the 9
grade (or the international equivalent) forward, whether related
to academic misconduct or behavioral misconduct, that resulted in a disciplinary action? These actions could include, but are not limited to: probation, suspension,
removal, dismissal, or expulsion from your institution.
p Yes p No p School policy prevents me from responding
To your knowledge, has the applicant ever been adjudicated guilty or convicted of a misdemeanor or felony?
p Yes p No p School policy prevents me from responding.
[Note that you are not required to answer “yes” to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged, sealed,
annulled, pardoned, destroyed, erased, impounded, or otherwise ordered to be kept confidential by a court.]
If you answered “yes” to either or both questions, please attach a separate sheet of paper or use your written recommendation to give the approximate date of each
incident and explain the circumstances.
Applicants are expected to immediately notify the institutions to which they are applying should there be any changes to the information requested in this application,
including disciplinary history.
p Check here if you would prefer to discuss this applicant over the phone with each admission office.
I recommend this student:
p No basis p p Fairly strongly p Strongly p Enthusiastically
lease write whatever you think is important about this student, including a description of academic and personal characteristics, as
demonstrated in your classroom. We welcome information that will help us to differentiate this student from others. Please feel free
to attach an additional sheet or another reference you may have prepared on behalf of this student.