PART I (to be completed by student)

Student Name ________________________________				S.S. Number _____-_______-__________
	LAST	FIRST	MIDDLE INITIAL
Address ____________________________________				Date of Birth ______/_______/__________
	STREET		APT. NUMBER
_____________________________________________________________________________
CITY		STATE		ZIP	PHONE

PART II (to be completed by school counselor - include information only if it is not included in other student documents.)  Please include the student's transcript and ACT (including sub scores)/SAT I Scores.

Confidentiality: We value your comments and ask you to complete this form in the knowledge that it will be used in the admissions process and becomes part of the student’s record while attending Hanover College.
Hanover College does not discriminate on the basis of race, creed, color, national origin, sex, marital status, age, sexual orientation or physical disability in its educational programs or activities.

Counselor's Name _____________________________ Title ______________________________

High School ____________________________________________________________________
				COUNTY
Address _______________________________________________________________________
	STREET		CITY	STATE	ZIP

Percentage of class attending:  Four-Year ____ Two-Year ____ institutions.  H.S. CEEB Code ________

Grading Scale:  4.0  5.0  10.0  12.0  Other _______________ Passing grade is ______________.

Student's GPA __________ GPA includes (Check all that apply):

9th Grade	10th Grade	11th Grade	12th Grade
Weighted	Unweighted

Student ranks _____ in a class of ______                We do not rank

Is the student's course selection, among those available at your school:

Most Demanding

Demanding

Average

Below Average

 

How would you  rate the applicant  in terms of:	No basis for judgement	Poor	Below Average	Average	Above Average	Outstanding
Academic Ability
Creative Talent
Motivation to study
Self-discipline
Emotional maturity
Leadership ability
Character
Energy level

 
PART III (to be completed by school counselor)

Please comment on the following items which reference the student's ability and character.  Attach additional pages if more space is needed. (A recommendation letter may replace Part III)
 
 
 
Academic Ability:
 
 
 
 
 
Personal Character:
 
 
 
 
 
Is the academic record of this student an accurate indication of the student's ability?
If not please describe the circumstances.
 
 

Counselor Statement:

Courses in Progress

 

I recommend this student:   With reservations  Fairly strongly Strongly Enthusiastically  

Counselor's Name ____________________________________ Phone (____)______________________________
Counselor's Signature __________________________________ Date ____________________________________