Important Instructions (please read): In addition to gaining insight into your academic and extracurricular achievement, this Student Questionnaire will help us learn more about you as a person. The "Secondary School Report" and the "Counselor Recommendation" is expected to present some sense of your promise for further personal and intellectual growth. Conveying your "unique" qualities is not an easy task. Therefore, we would appreciate your giving us an honest estimation of yourself. Some of the questions are easy, factual. Some are hard and require some thought on your part. Please consider all of your life experiences, not just what has happened to you at school. We ask these questions because the colleges ask us the same ones about you.

PLEASE - Make of copy of the completed questionnaire (if you send in this original.) You will find it useful as you start to write your resume and complete college applications and essays.

Please print in black ink or type. Unless your handwriting is very neat, please type your responses. Thanks! Feel free to email me your responses at vgarner@ssfs.org

NAME___________________________________________________________________

ADDRESS________________________________________________________________

_________________________________________________________________________

HOME PHONE_______________________ SOCIAL SECURITY #__________________

EMAIL _____________________________ DATE OF BIRTH______________________

PLACE OF BIRTH____________________ ENTERED SSFS IN (YEAR)______________

(GRADE AT ENTRY)_________________

MIDDLE OR SECONDARY SCHOOL(S) ATTENDED PRIOR TO SSFS:

NAME LOCATION GRADES(DATES)

_____________________________ _____________________________ ______________

_____________________________ _____________________________ ______________

PARENT NAME____________________________________________________________

RELATIONSHIP TO YOU: Mother Father Grandparent Guardian

OCCUPATION (describe briefly)_______________________________________________

EMPLOYER (name of business or organization)___________________________________

COLLEGE(S) ATTENDED

NAME YEAR DEGREE

_____________________________ _________ __________________________________

_____________________________ _________ __________________________________

PARENT NAME_____________________________________________________________

RELATIONSHIP TO YOU: Mother Father Grandparent Guardian

OCCUPATION (describe briefly)________________________________________________

EMPLOYER (name of business or organization)____________________________________

COLLEGE(S) ATTENDED

NAME YEAR DEGREE

____________________________ ___________ _________________________________

____________________________ ___________ _________________________________

PLEASE CIRCLE ALL THAT APPLY TO YOU: Parents Married Parents Divorced

Parents Never Married Both Parents Living Mother Deceased

Father Deceased Guardian Someone Other Than Mother or Father

SIBLINGS (please list oldest to youngest)

FIRST NAME AGE SCHOOL/COLLEGE ATTENDED OCCUPATION

_________________ _____ _________________________________ ________________

_________________ _____ _________________________________ ________________

_________________ _____ _________________________________ ________________

 ACTIVITIES (PLEASE COMPLETE THE ATTACHED CHARTS)

Colleges are not looking for a long list of activities. They prefer in-depth participation and leadership in a few interests. They want to know that you have some initiative, curiosity, and motivation beyond your studies – that you are an interesting and involved person. With this in mind, complete the attached charts.

List the school activities in which you have been involved for grades nine through twelve. In listing sports, mention JV or Varsity status and include co-captain, captain if you have earned these positions. Mention any special responsibilities you have had in these activities: amount of time, commitment involved, and/or any special recognition you have received (i.e. editor of the yearbook, class officer.) Note how many years you have been involved in this activity, include any in which you expect to participate during your senior year.

NAME_____________________________________________

SOCIAL SECURITY NUMBER________________________

ACADEMIC INTEREST QUESTIONS

1. What courses have you enjoyed the most in high school? Why?

  

 

 

2. What courses have given you the most difficulty? Why?

 

  

 

3. What specific courses might you like to study in college? Are you planning to pursue a particular major? Which one? (Please do not mistake this question to mean, "you have to choose a major now!" If you’re not sure, that’s okay! Just tell us what you’re thinking is today.)

 

 

 

 

4. What might you hope to do after graduation from college?

EXTRACURRICULAR INTERESTS

1. What activity or organization in school has meant the most to you? Why?

 

 

 

 

2. How do you spend your time outside of school?

 

 

 

3. Has any summer experience, work, or study been of significant importance to you? Please describe.

 

 

 

 

4. Have you traveled or lived in different localities? Where? Comment on any significant travel experiences.

 

  

 

 

5. What extracurricular activities do you hope to pursue in college?

SUPPLEMENTAL INFORMATION

1. Do you play a musical instrument? If yes, give name of instrument and how long you have been playing.

 

 

 

2. Comment on out of school activities that are important to you, including hobbies, clubs, political involvement, recreational outlets, or any other special interest you have developed. Include church or temple participation, indicating positions held.

 

 

 

 

 

3. How much reading do you do outside of required course work and of what type? Please list titles (and authors) of books that you have read in the past two years. If you read any newspapers or magazines regularly, list those too.

PERSONAL RESPONSES

1. Is your high school academic record an accurate measure of your ability and potential? If not, what do you consider the best measure of your potential for success in college work?

 

 

 

 

 

2. What circumstances, if any, have interfered with your academic performance?

 

 

 

 

 

3. Describe your best friend (no name is necessary.)

 

 

 

 

 

4. What do you consider your greatest strengths?

 

  

 

 

 

5. What do you consider your greatest weaknesses?

 

  

 

 

6. Is there anything else you would like to share in order to help us make an accurate appraisal of you to colleges?