Complete the following questionnaire to assist you when making a resume and/or application. This will also help people when writing a letter of recommendation. You need to bring this to your IEP/ITP meeting.
Name: Birthdate:
Address: Telephone#:
City: State: Zip:
SS#: GPA WT:
Unweighted GPA: Class Rank: of
Ethnicity: (Optional)
College Test Scores
PSAT: date taken PSAT: date taken
Verbal (V) Verbal (V)
Math (M) Math (M)
SAT I: date taken SAT I: date taken
V V
M M
Subject Test Score
ACT: date taken Score/English Math
Reading Science Composite Score
Subject Test Score
Advanced Placement Tests
STAR Grade level Reading Math
Awards or Honors
College Plans
List colleges or training programs you are considering:
1. 2.
3. 4.
What classes do you get the best grades in?
Career Goals:
List ten adjectives that describe you. Circle 3 that best describe you.
List the first and last names of 3 teachers or staff members who can comment favorably on your work habits, character and academic abilities.
1.
2.
3,
What are your strengths?
What would you like to improve about yourself?
List awards or honors you have earned.
List any special activities you are planning to participate in after high school? (sports, art, clubs, leadership. Volunteer activities, etc.)
FAMILY INFORMATION
Highest level of education completed by:
Mother
Father
Do you plan to apply for financial aid?
Do you receive SSI?
Answer the following:
What do you see yourself doing in 5 years?
Describe any significant events or influences in your life.
Describe a project or class assignment that was meaningful to you.
Describe any obstacles that you may have had to overcome.
