STUDENT REFLECTION SHEET & COLLEGE QUESTIONNAIRE
PART A
Members of the Class of 2016
As part of the comprehensive college counseling process, we ask you to complete the following questions
with care and detail. Your responses will be used to assist us as we write your letter of recommendation. Use
as many pages as you need. ALL RESPONSES MUST BE TYPED. You must turn a hard copy into the guidance
office no later than Friday, May 1st, 2015. Part B will be available May 25, 2015, on our website.
Full Name: Click here to enter text.
Year Entered St. Agnes: Click here to enter text.
Student Email (list all that you check): Click here to enter text.
Student Cell Phone: Click here to enter text.
I.
Parent Email: Click here to enter text.
FAMILY INFORMATION
Father’s Name: Click here to enter text.
Occupation: Click here to enter text.
Attended College?
Yes
No
Colleges Attended:
 Undergraduate:
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Year of Graduation: Click here to enter text.
 Graduate: Click here to enter text.
Year of Graduation: Click here to enter text.
Other: Click here to enter text.
Mother’s Name: Click here to enter text.
Occupation: Click here to enter text.
Attended College?
Yes
No
Colleges Attended:
 Undergraduate:
Click here to enter text.
Year of Graduation: Click here to enter text.
 Graduate: Click here to enter text.
Year of Graduation: Click here to enter text.
Other: Click here to enter text.
If you have step-parents, please list their name(s), occupation and school information
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Do you have siblings? If so, please list their names, ages and college/university he/she attends, if applicable.
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Would you be the first person in your family to earn a college degree?
II.
Yes
No
COLLEGE SEARCH
Knowing that you are still thinking about your choice of major, is there a particular major that currently
stands out as an option?
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Possible career plans (one or several or undecided):
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Do your parents agree with your choice in possible major(s) or career plans? If not, what have they
suggested?
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Try to identify some of your criteria for making decisions about college (check all that apply).
Size of School:
XS (<1000)
S (1000-3000)
M (3000-8000)
L (8000-15000)
XL (>15000)
Campus Setting:
Hardcore Urban (in the heart of a city, no real sense of campus)
Urban (in a city but w/ a campus feel)
Suburban (close to a city but removed enough to have its own feel)
Rural (campus pretty much the only source of entertainment)
Hardcore Rural (nothing but the college)
Location of Campus:
Houston
Texas
Southeast
Southwest
West Coast
New England
Midwest
Great Plains
International
Do your parents agree with this?
Yes
No
Comments: Click here to enter text.
How challenged do you want to be academically?
Rigor Galore
Very Rigorous
Somewhat Rigorous
Somewhat Easy
Mid-Atlantic
Cake Walk
Social Climate
From a social perspective, there is one big question with which you’ll need to grapple. Do you want to go to a school where
everyone holds similar beliefs and values or do you want to attend a college with a greater diversity of opinion? There is no
wrong answer to this question but you must make sure you’ve considered the different options. The following questions will
try to assess where you stand on some issues. Check all that apply.
Student Politics:
Left
Moderate
Religious Affiliation (Click here to enter text. ):
Willingness to consider an all-women’s college:
Right
None
Light
Moderate
No way
Perhaps
Yes
Strong
Please click on the box to access the pulldown of answer choices.
Campus Setting: Choose an item.
Financial Aid/Scholarship: Choose an item.
Do you have any specific colleges in mind at this time? Indicate if you have just heard of the college (H),
visited the college (V), or had some contact with a coach or professor (C/P). Are you a legacy? (L)
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List in order of preference your current top four college choices:
(1) Click here to enter text.
(3) Click here to enter text.
(2) Click here to enter text.
(4) Click here to enter text.
Please give specific reasons for these choices (size, location, field of study, public or private, etc.)
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List other factors that may affect your college choice (i.e., finances, distance, family relationships,
circumstances, etc.)
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III.
PERSONAL
Service
What have been your most significant contributions to St. Agnes and/or the Houston community?
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Leadership
In which ways have you demonstrated leadership either in or out of the classroom? Describe in detail.
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Character
List five adjectives you would use to describe yourself. Why do you choose these words?
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What adjectives would your closest friends use to describe you?
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What are your principal strengths? Your most conspicuous shortcomings, either academic or personal?
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What type of person is most appealing or enjoyable to you? What are two or three traits you most admire in
others?
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Activities
What extracurricular activity has been the most meaningful to you? Why have you chosen this activity?
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What are your hobbies or outside interests? Why are these activities important to you?
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Do you plan on playing competitive sports in college (interest in athletic recruiting)?
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Have you held a job (either in the summer or during the year)? If so, what did you do and for how long?
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What are your plans for this summer?
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Reflections
What type of student are you? What academic settings and assignments make you thrive?
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What subject(s) have you enjoyed and interest you the most and why?
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What subject has presented the most challenge and why? What steps have you taken to overcome this
challenge?
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In what ways (events, experiences, etc.) do you feel you have changed/grown during high school?
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What are one or two accomplishments up to this point in your life that have given you the greatest
satisfaction or sense of pride?
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Is your high school record an accurate measure of your ability and potential? Have there been circumstances,
personal or academic, that have interfered with your academic performance?
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Which teachers and/or staff know you best?
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List the books you have read on your own (NOT as a class assignment) in the last 12 months.
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Hodge Podge
(Don’t ponder too long. These are just to get to know you better.)
Favorite Book Click here to enter text.
Top Five on your Playlist Click here to enter text.
Favorite movie Click here to enter text.
Favorite TV Show
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Favorite magazine
Favorite time of day
Favorite place
Favorite Website
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