Applicant Information

Student's First Name *

Student's Middle Name

Student's Last Name *

Student's Email Address *

Student's Date Of Birth (mm/dd/yyyy) *

Current year courses - please indicate title, level (AP, IB, advanced honors, etc.) and credit value of courses you are taking this year. If you are taking more than 6 courses per semester, your counselor will have an opportunity to attach your senior schedule to this form.

First Semester

Course 1

Course 2

Course 3

Course 4

Course 5

Course 6

Second Semester

Course 1

Course 2

Course 3

Course 4

Course 5

Course 6

Your Counselor's Email *

Confirm Counselor's Email *

Important Privacy Notice: Under the terms of the Family Education Rights and Privacy Act (FERPA) you may have access to your recommendation after you matriculate.
Please indicate your preference: *

Yes, I do waive my right to access and I understand I will never see this recommendation.

No, I do not waive my right to access and may someday choose to review this recommendation.

Signature *

clear

Date *

Clicking Submit will result in this form being routed to your guidance counselor for review and recommendation.