PERSONAL DATA FORM/FACT GATHERING/COLLEGE …



STUDENT INFORMATION FORM 2021-2022

for Counselor Letter of Recommendation from Mr. Jones

Directions to the Student: This form must be typed. Your answers need to be detailed but not wordy. As the purpose of this packet is to give me useful, complete information that I can send to your colleges, it’s in your best interest to do this task well. I may be quoting from your answers when I write your counselor letters, so write thoughtfully. When it is complete, you must save the document with YOUR name in the file name and email it to me at thomas1.jones@. (Do not SHARE your document—it must be sent as an attached PDF or Word file.) Your completed assignment must be in my inbox on or before August 15, 2021, and will count for 100 points in your IB 12 English grade.

1. Last name: First Name:

2. Name you prefer to be called: Today’s date:

3. Your phone: Email:

4. Father’s name: Father’s occupation:

Father’s phone: Father’s email:

5. Mother’s name: Mother’s occupation:

Mother’s phone: Mother’s email:

6. Will you be the first person in your family to attend college?

7. Primary Language spoken at home:

8. Do you receive or qualify for free/reduced lunch (answer yes or no—I must mark this for you on applications to allow you to get fee waivers)?

QUICKIE QUESTIONS: Answer in about 40 words each

*What do you read for fun?

*Name three things you can’t live without.

*What are your hobbies/interests?

*What is your favorite academic subject? Why?

*What is a special talent or interest that you think would be most interesting to colleges?

SHORT ANSWER QUESTIONS (Max: 200 words each)

1. SCHOOL ACTIVITIES: Which school activity/club/sport has been most meaningful for you during your years at CHS? Why?

2. YOUR ROLE AT CHS: Many colleges want to know how you have fit into the “big picture” of your high school over the years. Tell me how you have contributed to the school culture here. After you graduate, why will you be missed by the underclassmen and teachers of CHS?

3. COMMUNITY ACTIVITIES: Describe something you’re proud of having accomplished in an

outside-of-school activity (music/organizations/dance, etc.) and why it is significant to you.

4. EXPERIENCES: Describe the community service, travel, or work experience that has meant the most to you & why.

5. FUTURE PLANS: Where do you see yourself in ten years? Career? Location? Why?

6. GRADES AND TEST SCORES: Do you think your grades/GPA and standardized test scores are a good indication of who you are as a student? Why or why not? If not, why is there a discrepancy?

7. LEADER OR TEAM PLAYER: Would you describe yourself as a leader or as a team player? (Or both?) Give an example of a time when you proved either your leadership skills or your ability to work as part of a larger group toward a common goal.

8. LESSON LEARNED: Briefly describe a time when you did not achieve a goal or suffered a setback that shook your determination a bit. How did you recover? How did it change you for the better?

9. THE “X” FACTOR: What do you wish you could tell colleges that you don’t think you’ll be able to work into your application? Something fun, something serious, something important—anything that you think helps create a fuller picture of you for college admissions officers.

10. IB LEARNER PROFILE: The characteristics listed below are used to describe IB learners. Choose the TWO characteristics that best describe you as a learner. For each, give a SPECIFIC example or anecdote that shows how you have demonstrated this quality.

• Inquirer: Curious & independent learner who loves learning

• Knowledgeable: Explores concepts, seeking in-depth knowledge

• Thinker: Approaches complex problems critically & creatively

• Communicator: Expresses ideas confidently & creatively

• Principled: Acts with honesty & integrity; takes responsibility for actions

• Open-minded: Open to perspectives & values of others

• Caring: Shows empathy & compassion; personal commitment to service

• Risk-taker: Approaches unfamiliar situations with courage & independence of spirit

• Balanced: Understands importance of intellectual, physical & emotional balance

• Reflective: Gives thoughtful consideration to his/her learning & experience

a. Characteristic & example:

b. Characteristic & example:

11. FAMILY: Briefly describe your family—who you live with, your heritage, what you do together, etc.

12. ADVERSITY: Explain any situations that have required you to overcome adversity or obstacles. How did you deal with the situation? Did you become stronger? How?

13. YOUR EXTENDED ESSAY: What is your Extended Essay topic? Why is this topic of interest to you?

14. CAS: What are the major activities you’ve been involved in for your CAS experiences? If you are not a diploma student, what community service activities have you taken part in during high school?

15. YOUR HOOK: What is your “hook?” In every stack of college applications, there is one person that is remembered for something unique, interesting, or just funny. “The guy who plays in a jazz band on weekends.” “The girl who ran a marathon when she was twelve years old.” “The one who made it to the semi-finals of American Idol.” What will make you stand out to admissions officers—and isn’t already apparent on your application, transcript or test scores? Write a one-sentence “hook” about yourself that will make admissions officers remember your application long after they’ve read it.

16. YOUR FUNNY STORY: In 200-300 words, relate an interesting or amusing story about yourself from your high school years that you will probably not be able to find a way to include in your application.

17. YOUR APPLICATION ESSAY DRAFT: Choose one of the following 2021-2022 Common Application topics and write a response of 400-600 words in this document. Failure to complete this part will result in a loss of 50 points from the total grade for this assignment.

1. Some students have a background, identity, interest, or talent that is so meaningful they believe their application would be incomplete without it. If this sounds like you, then please share your story.

2. The lessons we take from obstacles we encounter can be fundamental to later success. Recount a time when you faced a challenge, setback, or failure. How did it affect you, and what did you learn from the experience?

3. Reflect on a time when you questioned or challenged a belief or idea. What prompted your thinking? What was the outcome?

4. Reflect on something that someone has done for you that has made you happy or thankful in a surprising way. How has this gratitude affected or motivated you?

5. Discuss an accomplishment, event, or realization that sparked a period of personal growth and a new understanding of yourself or others.

6. Describe a topic, idea, or concept you find so engaging that it makes you lose all track of time. Why does it captivate you? What or who do you turn to when you want to learn more?

WRITE YOUR RESPONSE BELOW:

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