MULTIPLE MEASURES SELF-REPORT UPDATE FORM
Oceanside Room 3334; San Elijo Room 101; CLC Room 104
Submit completed form to the Testing Office or email to testing@miracosta.edu
Questions? Call 760-795-6685
STUDENT ID (SURF ID):_________________________ DATE OF BIRTH (DOB): ____________________
LAST NAME: _________________________________ FIRST NAME: _________________________________
EMAIL ADDRESS: ___________________________________________________________________________
HIGH SCHOOL GRADUATION DATE (month & year):_______________________________________________
HIGH SCHOOL NAME: _______________________________________________________________________
HIGH SCHOOL CITY, STATE (or country): _________________________________________________________
What was your total estimated high school GPA? __________________
If you do not have a GPA (grade point average), please mark the ranking/grading closest to what you received for
your overall high school/secondary school performance:
Unsatisfactory
Below satisfactory
Satisfactory
Good
Very good
Please list the high school Math courses you have taken and grades earned:
Course Title (ex. Algebra 2)
Please list the English courses you have taken in high school and grades earned:
Course Title (ex. English 12)
By signing below, I certify that the information provided is true and correct to the best of my knowledge:
Student Signature: _________________________________________________ Date: __________________
Form must be filled out entirely.
Students may be asked to provide a copy of their high school transcript (official or unofficial) for verification purposes.
For Office Use Only: Test Codes: ________________ Entered in PS:_________ Staff Initials: __________
