• After completing all the relevant questions below, give this form to your secondary school counselor or another school official who knows you better.

  • School you now attend

  • CEEB/ACT Code


  • By signing this form, I authorize every school that I have attended to release all requested records and recommendations to colleges to which I am applying for admission. I also authorize employees at these colleges to confidentially contact my current and former schools should they have questions about the information submitted on my behalf.

  • To review all recommendations and supporting documents submitted by me or on my behalf, I...

  • I understand that my decision may lead my counselors or teachers to decline to write recommendations on my behalf. I also understand that my decision may lead colleges to disregard any recommendations submitted on my behalf.

  • I understand that my waiver or no waiver selection above pertains to all colleges to which I apply and that my selections cannot be changed after any recommendation or application submission.

  • Applicant's Signature


  • Complete your evaluation for this student. Be sure to sign below.

  • Counselor Name & Signature

  • Title

  • School

  • School Address
  • Counselor's E-mail Address

  • Counselor's Telephone Number

  • School Website Address

Background Information

  • Class Rank

  • The rank is

  • Class Size

  • How many additional students share this rank?

  • Period covered

  • Cumulative GPA

  • On what scale?

  • This GPA is

  • Period covered

  • The school's passing mark is

  • Highest GPA in class

  • Graduation Date

  • Percentage of graduating class immediately attending:

  • Does your school require students to perform volunteer service?

How many courses does your school offer?

  • AP

  • IB

  • Honors

If school policy limits the number a student may take in a given year, please list the maximum allowed:

  • AP

  • IB

  • Honors

  • Are classes taken on a block schedule?

  • Is the applicant an IB Diploma candidate?

  • Is the applicant an Advanced Cambridge (AICE) Diploma Candidate?

  • Is the applicant an AP Capstone candidate?

  • In comparison with other college preparatory students
    at your school, the applicant’s course selection is:


  • Compared to other students in his or her class year, how do you rate this student in terms of:

  • Academic achievement

  • Extracurricular accomplishments

  • Personal qualities and character


  • Has the applicant ever been found responsible for a disciplinary violation at your school from the 9th grade (or the international equivalent) forward, whether related
    to academic misconduct or behavioral misconduct, that resulted in a disciplinary action?

  • Please use your written recommendation to give the approximate date of each incident and explain the circumstances. Applicants are expected to immediately notify the institutions to which they are applying should there be any changes to the information requested in this application, including disciplinary history.


  • I recommend this student:

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