_________________________________
Student Name
_________________________________
(PLEASE PRINT)
Counselor Name
SENIOR
QUESTIONNAIRE
Please Complete and Return to your assigned counselor
no later than: September 12, 2014
PURPOSE:
In order to write a thorough evaluation, Teachers and Counselors
should have a completed copy of the Senior Questionnaire prior to
completing any Letter of Recommendation or Secondary Report.
PROCEDURE:
After completing this form, be sure you make a copy for your files
before you turn the original in to your College Counselor. * When
requesting a Teacher Recommendation, a copy of the Senior
Questionnaire should be given to the teacher.
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* Please refer to last page of questionnaire for complete listing of Student –
Counselor Assignments.
SCRANTON PREPARATORY SCHOOL COUNSELING DEPARTMENT
SENIOR QUESTIONNAIRE
DIRECTIONS: Please fill out all sections pertinent to you. If possible TYPE your
responses, or convert this form to your own WORD PROCESSING program.
Since this questionnaire will be used by Faculty and your College Counselor for Letters
of Recommendation and the Secondary School Report, you should give as much
information about yourself as you can. Return the completed form to your counselor.
LAST NAME_________________________________FIRST____________M.I._____
DATE ENTERED SCRANTON PREP____________ DOB________________
ACADEMIC INFORMATION:
1. G.P.A.
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Total Number of AP Courses
_______________________
Total Number of Honors Courses
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SAT/VERBAL
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SAT/MATH
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SAT WRITING
_______________________
ACT
Composite Score_______________________
SAT II
_________________________
* It is important to identify specific colleges requiring SAT II’s. If required, you need
to register for these tests
** In accordance with The College Board's Score Choice Policy, SAT or ACT scores
will no longer be included on transcripts or secondary school reports - Therefore,
students must report their scores to colleges via The College Board.
** It is extremely important that students report their scores to Scranton Prep when
taking SAT or ACT test using our School Code: 394-440
2. Describe what type of student you are. What academic setting or type of
assignments makes you thrive? What interests you most?
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Any College Credits Earned? _____________
Name of Course:______________________
Credit:_______________________________
3. Intended Major in College:_________________________________________
Intended Career: _________________________________________________
□ Div I
Intended Athletic Participation:
Have you registered with the NCAA?
4. a.
□ Yes
□ Div II
□ Div III
□ No
Describe the single academic accomplishment (major paper, science project or
experiment, artistic project or accomplishment) of which you are most proud, and
tell why you take special pride in it.
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b. Is there a non-academic accomplishment you also consider significant? If so,
please describe your success.
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5.
List five adjectives which you believe best describe you.
a.
__________________
d.
_________________
b.
__________________
e.
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c.
__________________
6. EXTRACURRICULAR ACTIVITIES
ACTIVITY AND ACHIEVEMENT RECORD: Place an X in the column
indicating the year of participation. Please use full names of activities and the
organizations rather than abbreviations. Indicate after each activity any office held or
award received.
SCHOOL STUDENT GOVERNMENT ACTIVITIES
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SCHOOL CLUBS,COMMITTEES & ORGANIZATIONS
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COMMUNITY SERVICE: TOWARD GRADUATION
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COMMUNITY SERVICE: BEYOND GRADUATION REQUIREMENT
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10
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OFF CAMPUS ORGANIZATIONS & ACTIVITIES
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10
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12
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10
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HOBBIES AND SPECIAL INTERESTS
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10
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EMPLOYMENT : APPROXIMATE DATES & # OF HOURS PER WEEK
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10
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AWARDS & HONORS: ON-CAMPUS
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SPORTS: (SCHOOL TEAMS, INTRAMURALS, OFF CAMPUS LEAGUES)
5
AWARDS & HONORS OFF-CAMPUS
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10
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ANY OTHER ACCOMPLISHMENTS
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10
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7. ETHNIC BACKROUND
In this section indicate with an X your race, nationality, or ethnic background.
American Indian
East Indian/Pakistani
Alaskan Native
Japanese/Japanese American
Black/African-American
Korean
Chicano/Mexican American
Polynesian
Latino/Other Spanish-American
Other Asian
Philipino/Fillipino
Caucasian
Chinese/Chinese American
Other: Specify
Is a second language spoken in the home?
Yes □
If so, what is the second language?
__________________
No □
8. FAMILY: Is there anything unusual about your family…..cultural background,
shared interest and activities, size, crises, etc. ---that has had a significant impact
on you? Why?
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Describe any circumstance in your life which you feel has helped to shape your
character, personality, and attitudes.
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9. DISTINGUISHING QUALITY: List what you believe to be your single, most
admirable, or most distinguishing trait or quality. Explain in several sentences.
(Think about what aspects of yourself you would like to have stressed to colleges.)
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10. GROWTH AREA: What do you perceive in your academic or personal growth
that needs further development?
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11. ADDITIONAL COMMENTS: Is there any further information that you would
like your Counselor or Teacher to highlight in a description of you that would be
sent to a college?
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12. List the two faculty members (besides your guidance counselor) that you plan to
ask for a college recommendation.
1.__________________________________________
2.__________________________________________
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REMINDER DUE: SEPTEMBER 12, 2014
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