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Mid-Term Report

This form gives us information about your current classes. If you are currently enrolled in your first term of
college, this report is required. For all other students, it is optional. (You may want to submit this report if your
grades in current classes are part of an upward trajectory.)

Student’s Name: ____________________________________________________________________________________


Student’s Date of Birth: ______________________________________________________________________________
Name of Current College: _____________________________________________________________________________

Ask each of your current instructors to complete the information below. Make a copy of the form for your records, then
mail the original to us at:

Clark University
Undergraduate Admissions
950 Main Street
Worcester, MA 01610

Course Code/Number: _______________________________________________________________________________


Course Title: _______________________________________________________________________________________
Instructor’s Name: __________________________________________________________________________________
Current Grade: _____________________________________________________________________________________
Comments: ________________________________________________________________________________________
__________________________________________________________________________________________________

Course Code/Number: _______________________________________________________________________________


Course Title: _______________________________________________________________________________________
Instructor’s Name: __________________________________________________________________________________
Current Grade: _____________________________________________________________________________________
Comments: ________________________________________________________________________________________
__________________________________________________________________________________________________
Clark University | Mid-Term Report | 1
Course Code/Number: _______________________________________________________________________________
Course Title: _______________________________________________________________________________________
Instructor’s Name: __________________________________________________________________________________
Current Grade: _____________________________________________________________________________________
Comments: ________________________________________________________________________________________
__________________________________________________________________________________________________

Course Code/Number: _______________________________________________________________________________


Course Title: _______________________________________________________________________________________
Instructor’s Name: __________________________________________________________________________________
Current Grade: _____________________________________________________________________________________
Comments: ________________________________________________________________________________________
__________________________________________________________________________________________________

Course Code/Number: _______________________________________________________________________________


Course Title: _______________________________________________________________________________________
Instructor’s Name: __________________________________________________________________________________
Current Grade: _____________________________________________________________________________________
Comments: ________________________________________________________________________________________
__________________________________________________________________________________________________

Course Code/Number: _______________________________________________________________________________


Course Title: _______________________________________________________________________________________
Instructor’s Name: __________________________________________________________________________________
Current Grade: _____________________________________________________________________________________
Comments: ________________________________________________________________________________________
__________________________________________________________________________________________________

Clark University | Mid-Term Report | 2

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