(OPTIONAL FORM: Please print, fill out, and give to your High School Counselor to report your application activity.)

To be filled out by the Student:
Fill out the information in the top half of this form, and give it to your high school guidance counselor/office to complete and forward, along with your application credentials (transcript, test scores, recommendation s) to the schools you select below. Create a copy of this form for each school to which you are applying.

Name ________________________________________________		SSN ________________
Address ____________________________________________________________________
City ______________________________________	State _______	Zip __________________

   
To be filled out by the Counselor:
Please fill out the following information, attach this student's application credentials (transcript, test scores and letters of recommendation) and forward them to admissions offices checked above.

At the end of ____ semesters, the student ranked ____ out of ____.
This ranking is __ exact  __ approximated.

Please list any course work in progress that does not appear on the student's transcript:

Subject Area	Semester 7 Unit/Grade (If not on transcript)	Semester 8 Unit/Grade (If not on transcript)
_______________________________________	____/____	____/____
_______________________________________	____/____	____/____
_______________________________________	____/____	____/____
_______________________________________	____/____	____/____
_______________________________________	____/____	____/____
_______________________________________	____/____	____/____
____ I recommend this student for admission. ____ I do not recommend this student for admission. ____ Please call me regarding this student's application.
Counselor's Signature ______________________	Date ____________
High School _____________________________	High School Telephone (____)____-_______