Secondary School Report

Please complete applicant information below and submit to your secondary school counselor or another school official who knows you better. The designated school official must complete all questions in the academics and evaluation sec- tion and return the signed form to the Office of Admission. APPLICANT INFORMATION: Applicant Name: Date of Birth:

School You Now Attend: CEEB/ACT Code:

TO SCHOOL COUNSELOR OR SCHOOL OFFICIAL: The student listed above is applying for admission to Merrimack College. We appreciate your assistance in providing the information requested below. This form is intended to serve as a review of academic and disciplinary standing. This form, when completed, should be sent directly to the Office of Admission.

Official Name/Title:

School: Email/Phone:

ACADEMICS

Cumulative GPA: _____ on a _____ scale, covering a period from (mm/yyyy) _____ to _____

[_] Weighted [_] Unweighted The school’s passing mark is: _____

Expected graduation date: (mm/dd/yyyy)

EVALUATION

1. Has applicant been found responsible for a disciplinary violation at your school? [_] Yes [_] No [_] Unable to Answer

2. Has applicant been adjudicated guilty or convicted of a misdemeanor or felony? [_] Yes [_] No [_] Unable to Answer

3. In comparison to other college preparatory students at your school, the applicant’s course selection is:

[_] most demanding [_] very demanding [_] average demanding [_] less than demanding [_] prefer not to respond

4. Compared to other student is his/her class year, I would give this applicant an overall rating of:

[_] one of the top few I’ve encountered [_] excellent [_] above average [_] average [_] below average

5. I recommend this student: [_] enthusiastically [_] strongly [_] fairly strongly [_] with reservation [_] no basis

SIGNATURE: DATE:

Please send completed form to the Office of Admission: [email protected], by fax to 978-837-5133, or mail to 315 Turnpike Street, North Andover, MA 01845.