H I R A M   C O L L E G E    SECONDARY  SCHOOL  REPORT

Vice President for Admission Hiram College P.O. BOX 96 Hiram, OH 44234 800/362-5280

Legal name:	__________________________	_________________________	____________________
	Last	First	Middle

Permanent address:	_________________________	______________	___________________	________
		Number and Street

_______________________	____________________	___________________	_________________
Town/City	State	Zip	Country

Home phone number:

_______________________

Social Security Number:

________-________-________

GUIDANCE OR COLLEGE COUNSELOR: Please complete this form and return it to us at the address located at top right. Please enclose a transcript which includes courses taken, year and grades earned, as well as courses in progress. Notation of honors, accelerated, or Advanced Placement courses is requested. Test results, such as scores on SAT I/II and ACT tests should also be included. If possible, we would appreciate your sending us an explanation of the grading system your school uses and a school profile. You should return this information to us as soon as possible, but not later than March 15 for general admission or February 1 if the candidate wishes to be considered for academic scholarships. Confidentiality: Your comments will be held in the strictest confidence during the selection process and they will not become part of the candidate's official file if he/she matriculates at Hiram.
 

Name:	_______________________________________	Position: ____________________________________
	Please type or print

Secondary school: ________________________________________________________________________________

School Address:	_________________________	_____________	____________	_________	____________
	Number and Street	Town/City	State	Zip	Country

Office telephone: __________/__________-______________   Office fax: __________/__________-______________

School CEEB/ACT Code: ___ ___ ___ ___ ___ ___

The candidate's grade point average (G.P.A.) is ________________ on a ____________________ scale.

The G.P.A. includes (check all that apply):

____9th Grade	____11th Grade	____weighted
____10th Grade	____12th Grade	____unweighted

This candidate ranks ____________________ from the top in a class numbering ________________________.

This rank covers the period from	_________________________	to	_________________________.
	Month      Year		Month      Year

If precise rank is not available, please indicate rank to the nearest tenth from the top. _____________________________

This rank is (check one) ______ weighted ______ not weighted.  If your school does not rank, please check _____.

Of this candidate's graduating class, ________% plan to attend a four-year college.

Is the candidate’s curriculum among those available at your school (check one)

_____ below average _____ average _____ demanding _____ unusually demanding?

Do you feel you know the applicant (check one)  ______very well  ______well  ______not very well?

In what context(s) have you known the applicant? _________________________________________________

________________________________________________________________________________________

______ This student has passed the proficiency tests required by our state. ______ He/she did not pass the following proficiency tests required by our state:        __________________________________________________ ______ Our state does not require proficiency examinations. ______ Students at our school are exempt from proficiency exams required in our state/district.

EVALUATION: Please write a candid evaluation of the applicant. We welcome all information that will help us gauge the potential of this candidate and differentiate him/her from others. Please attach a separate sheet if necessary.

RATINGS: Please evaluate this candidate in comparison to other college-bound students in his/her class using the following scale: 1—truly outstanding (one of the top students I have known), 2—excellent (top 10%), 3—good (above average), 4—average, 5—below average.

Genuine interest in learning: ______ Academic potential: ______ Commitment to a rigorous college preparatory curriculum: ______ Leadership:______

Self-confidence: ______ Emotional maturity: ______ Respect accorded by the faculty: ______ Serious about the entire college selection process: ______

SIGNATURE: _____________________________________

DATE: __________________

 
I recommend this student (optional): ______ enthusiastically ______ strongly ______ fairly strongly ______ with reservation.

I would like to share additional information regarding this student. Please call me. ______

REMINDER: PLEASE RETURN AS SOON AS POSSIBLE, BUT NOT LATER THAN MARCH 15 FOR GENERAL ADMISSION OR FEBRUARY 1 IF THE APPLICANT WISHES TO BE CONSIDERED FOR ACADEMIC SCHOLARSHIPS.