BUTLER UNIVERSITY SECONDARY SCHOOL REPORT
TO THE APPLICANT (please print)

After completing the information in this section, give this form to your guidance counselor.

Student Name
Last (Family or Surname) _________________________ First ____________________
Middle (Complete) ___________________ Jr. etc ________

Address
Street ____________________________________________________________
City ____________________ State _____________________ Zip ____________ Country ____________

Social Security Number ____-____-_____ Telephone Area Code/Number______/____________
E-mail address ____________________

I am applying for: Early Admission I (postmark date Dec.1) Early Admimission II (postmark date Feb. 1) Admission III

TO THE HIGH SCHOOL GUIDANCE COUNSELOR
Confidentiality
We value your comments highly and ask that you complete this form in the knowledge that it may be retained in the student's file should the applicant matriculate at Butler. In accordance with the Family Educational Rights and Privacy Act of 1974, matriculating students do have access to their permanent files which may include forms such as this one. We do not provide access to admissions records to applicants, those students who are denied admission, or those students who decline an offer of admission. Again, your comments are important to us, and we thank you for your cooperation.

After completing the information below, please attach transcript(s).
Class rank ________ class size _______ The rank is weighted unweighted
The rank covers a period from (mo/yr) _____________ to (mo/yr) _____________

If a precise rank is not available, please indicate rank to the nearest tenth from the top _____________.
Cumulative grade point average ________________ scale _________________
Of this candidate's graduating class, ______________ percent plan to attend a four-year college.
The applicant's course selection is:
Honors/AP College Prep Average Less than Average
For Indiana High School counselors only: This student is on track for either the: Honor's Diploma Core 40 Neither

How long have you known the applicant and in what context?
_____________________________________________________________
What are the first words that come to your mind to describe the applicant?
____________________________________________________________

EVALUATION

Compared to other university-bound students whom you have advised, indicate (X) your rating of this student in terms of academic skills and potential.
No Basis Below average Average Above average Well above average Excellent (top 10%) One of the
top few
encountered
in my career
Creative, original thought              
Motivation
  		             
Independence, initiative              
Potential for growth
             
Overall evaluation
             

I recommend this student: With reservation Fairly Strongly Strongly Enthusiastically

REFERENCE
On a separate sheet of paper please feel free to write whatever you think is important about this student, including a description of academic and personal characteristics. We are particulary interested in the candidate's intellectual promise, motivation, relative maturity, integrity, independence, originality, initiative, leadership potential, capacity for growth, special talents, and enthusiasm. We welcome information that will help us to differentiate this student from others.

COUNSELOR INFORMATION

Counselor's signature _______________________________ Date _______________

Counselor's name (please print or type)_____________________________________

Title _______________________________

School ___________________________________ School CEEB code ___________

School address
Street __________________________________________________
City _____________________ State __________________
Zip _____________ Country _________________________

Office telephone Area code/Number ____/__________________ Extension _____

Fax ____/________________ E-mail address _______________________________

School CEEB code __________________________

Please mail this form with transcript(s) to:
Butler University, Office of Admission
4600 Sunset Avenue, Indianapolis, Indiana 46208-3485, USA