2011-12 Home School Supplement

HS

For Spring 2012 or Fall 2012 Enrollment

You may leave all school contact information (bottom of page 2) blank if you are stapling this Home School Supplement to the School Report before mailing.
Please type or print in black ink. This form should only be used by home school supervisors. Check specic college information in our online Requirements Grid
to ensure a member institution uses this form. Do not mail this form to The Common Application ofces.

TO THE APPLIC ANT

Female
Legal Name ___________________________________________________________________________________________________________________
Male
Last/Family/Sur (Enter name exactly as it appears on official documents.)

First/Given

Middle (complete)

Jr., etc.

Birth Date __________________________________________________________________ Social Security # _____________________________________

mm/dd/yyyy

(Optional)

Address ______________________________________________________________________________________________________________________
Number & Street

Apartment #

City/Town

State/Province

Country

ZIP/Postal Code

TO THE HOME SCHOOL SUPERVISOR

Philosophy
Please tell us why home schooling was chosen for this student, and explain your home schooling philosophy.

Grading Scale
Please explain the grading scale or other methods of evaluation.

Outside Evaluation
If the student has taken courses from a distance learning program, traditional secondary school, or institution of higher education, please detail them here.
In addition, if the student has taken any standardized testing other than those listed on page 2 of the Common Application, please also describe below.

2011 The Common Application, Inc.

HS-1/ 2011-12

Transcript
Subject

English

Course Title & Level (AP/College)

Date (To/From)

Grade

Primary Text Used

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Math

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Science

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Social
Studies

______________________________________________ ____________________ _________ ___________________________________________

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Foreign
Language

______________________________________________ ____________________ _________ ___________________________________________

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Arts

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Other

______________________________________________ ____________________ _________ ___________________________________________

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Supervisors Name (Mr./Mrs./Ms./Dr.) ________________________________________________________________________________________________

Please print or type

Signature _________________________________________________________________________________________________ Date _____________________

mm/dd/yyyy

Supervisors Address ____________________________________________________________________________________________________________

City/Town

State/Province

Country

ZIP/Postal Code

Supervisors Phone (_______) _____________________________________

____ Supervisors Fax (_______) _________________________________
________
Area Code

Number

Ext.

Area Code

Number

Supervisors E-mail _________________________________________________

Are you a member of a homeschoolers association? Yes No If yes, name of association ____________________________________________________

2011 The Common Application, Inc.

HS-2/ 2011-12