tHE COMMON APPLICATION 2010-11 MIDYEAR REPORT MR For Spring 2011 or Fall 2011 Enrollment TO THE APPLICANT ‘ter completing al the relevant questons below, give this form to your secondary schoo! counsaloror another schoo! ofa whe knows you beter. applying ‘via mall, please also gve that school official stamped envelopes addressod to each institution that requires @ Midyear Repor. Oremale Legal Name Cimaie TaatFamii/Sur_ (ater ame exaciy a8 appears oneal dacumenis) _ Pesven 0 Tree Birth Date Social Security # nia onion ‘dross. ‘School you now attend CEEBIACT Code ‘Current year courses—please indicate title, evel (AP. IB, advanced honors, etc.) and credit value ofall courses you are taking this year. Indicate quarter ‘lasses taken in the same semester on the appropriate semester line, First SomesterTimester Second Somesterrimester ‘Third Trimester IMPORTANT PRIVACY NOTE: By signing this form, | authorize all schools that | have attended to release all requested records covered under the Federal Eucational Rights and Privacy Act (FERPA) so that my application may be reviewed by the Common Application member institution(s) to which | am applying, |Murther authorize the admission officers reviewing my application, induding seasonal staff employed fr the sole purpose of evaluating applications, to contact ‘officials at my current and former schools should they have questions about the school forms submitted on my behalf. | understand that under te terms ofthe FERPA, after | matricuate | vill have access to this form and all other recommendations and supporting documents ‘submited by me and on my behalf, unless atleast one ofthe folowing is true: 1. The institution does not save recommendations post-matriculation (see list at www commonapp.org/FERPA). 2.1 waive my right to access below, regardless ofthe institution to which itis sent C1 Yes, 1 do waive my right to access, and | understand I will never see tis form or any other recommendations submitted by me or on my behat. EJ No,1'0 not waive my rignt to access, and | may someday choose to see this form or any other recommendations or supporting documents submitted by me ‘or on my behalf othe institution at vinich I'm enroling I that institution saves them after matrculate Required Signature “>. Date. TO THE SECONDARY SCHOOL COUNSELOR Pease submit this form when midyear grades are avallable ond of fist semester or second trimester) Attach applicant's ffi ranscrpt,Inudng courses in progress, a school profle, and transcript legend (Pease check transcript copies for readability) Use oth pages to complete your evaluation forts student. Be sure to sign below. Counselors Neme (MSDE, et) ‘Signature SS Date, THe ‘School ‘Schoo Address ‘iow sce Say ‘ial Ge Counselors Telephone (_) Counselor's Fax (_) ‘Secondary scool CEEB/ACT code ‘counselor's E-mail 2030 The commen pear, sues oraBackground Information any of the information on this page has change fortis student since the Secondary School Report was submited, pleas enter the new information in the appropriate section below. If your recommendation for this student has changed, please comment inthe space below or on a separate sheet. nothing has changed, you may leave this page lank. However your signature is stl require. case Rank as Sze Covering a peti rom » How many couse doe our sea fe = » 6. Hones Terenk s CJwigted [unweighted How many std share this rank? schol poy isthe umber astucentay ke, plz tthe axa lov Wwe do notrank. Instead, please indicate quartile ____—_—quintle_ decile APB Honors {sthe applicant an IB Diploma candidate’ [_]Yer [_]No Carulatve GP ona sel, covering apr tom —_ — eee ae Ce i Bee In comparison with other college preparatory students This GPA svete] unveghe. The scoas passing marks See ee Highest GPA in class _ Graduation Date ‘most demanding inmiaclyyrn ae Porcntge ot graduating cass immedi attend fou-yoar___twoearnsttutons | amanda Bebo average ow ing have youknown th studenten n what eaten? ‘Wat ae the tst words hat comet your indo describe this student? Ratings Compared to other students in his or her class year, how do you rate this student in terms of: Good ane (uelabove —Excllnt Outstanding we encod ender cheverent Esracuriclar aczomplshmens Personal qual and character OVERALL Evaluation Please use this space to elaborate on any changes inthe students academic record, personal demeanor, oF status at your schoo, (© Has the appcant ever been found responsible for a dscpinary violation at your schoo tom 9 grade (or the interational equivalent forward, whether related ty ‘academic misconduct or behavioral misconduct, that resulta in the applicant's probation, suspension, removal, dismissal, or expulsion trom your institutior[_]¥es L_]No ‘@ To your knowledge, has the applicant ever been adjudicated gulty or convicted of a misdemeanor, felony, or other crime? []¥es [1] No {Note thal you arent required to answer "ys" to this question, or provide an explanation if te criminal achuication or convict has been expunged, sealed, ‘annulled, parconed, destroyed, erased, impounded, or otherwise ordered tobe Kept conidential by a court) Iryou answered “yes” to elteror both question, please attach a separate sheet of paper or use your written recammendation to give the approximate date of each Incident and explain te cxcumstances. L. check here if you would prefer to discuss this applicant over the phone with each admission office, ‘recommend this student: [I] notasis (wth eseraton CIraity story Clstongly Clennasastely