Date Received By Counselor: ______(to be filled out by Ms. O’Neil ONLY)

Emily O’Neil

School Counselor - Lexington High School

781.861.2320 x69337,

Student's Full Name:

Email Address (one you check regularly):

Earliest Application Deadline and College Name (if known):

Is this Early Decision?

This completed questionnaire will provide information to assist in writing the counselor's statement.

A completed packet, along with your transcript request, needs to be handed in according to the LHS Request Deadlines given to you in Senior Seminar

PLEASE TYPE AND SEND BACK TO MS. O’NEIL THROUGH EMAIL

BE AS DETAILED AS POSSIBLE EVEN IF YOU FEEL THAT I KNOW YOU WELL

______

Please list four adjectives which you, your family or friends would use to best describe you. Include anecdotes or examples.

What have your high school years been like (academically & personally)?

Describe any particular experience or incident that has had a major impact on you, your goals, or values.

Do you receive any formal academic supports through the school (IEP/Resource, 504, ICAP)? If yes, please explain. Do you grant me permission to include this information in my statement? YES NO (Initial) ______

Is there anything on your transcript that your feel I should explain in my statement? (i.e., N, I, X, W, P, course change; grades that are lower/higher than you typically earn)

What circumstances, if any, have interfered with your academic or social performance at LHS? [i.e.: moving, cultural differences, accident, divorce, death, difficult home situations, or health problems]

What courses are you most enthusiastic about? Why?

Which course(s) gave you the most difficulty and how did you handle the challenge?

Was there a course at LHS that you were unable to take? If so, what was it, why was it so enticing, and what prevented you from enrolling in it?

What specific course(s) would you like to investigate or major in at college? Why? Have you had any experiences which informed and influenced this idea? Explain.

What do you see yourself doing in the future? Why?

What is important to you? What do you like to do more than anything else?

What do you choose to learn on your own? Please consider interests pursued beyond class assignments. What do your choices show about your interests and the way you like to learn?

How have you spent your summers (i.e., working, volunteering, taking classes, travelling, etc)? Be specific.

Please describe your community service involvement, including details of how long you participated in a project, the specific name of the project, and what grade/s you were in when you participated in the project. If you have done multiple community service projects, which one was the most meaningful and why?

If you have completed an "ACTIVITIES RESUME" please attach it and skip the next question.

List and describe any awards or honors-both academic and/or non-academic. List and describe any leadership roles you have (school and community).

Is there anything else you want to share with me so that I can write an accurate appraisal of you in your counselor statement? Or, just tell me something you think I should know that's not covered in any of these questions. Also, is there anything you feel I should omit from the counselor statement?

Emily O’Neil

781.861.2320 x69337

OPTIONAL GUARDIAN'S QUESTIONNAIRE FORM

(Recommended but not required)

Writer's Name & Relationship: ______

Student's Name: ______

1. What do you consider to be your son/daughter's most outstanding accomplishments over the past three to four years?

2. In what areas has your son/daughter shown the most development and growth during the past three to four years?

3. What do you consider to be his/her outstanding personality traits?

4. Are there any particular interests, projects, talents, or hobbies you might see that we are not aware of here?

5. Has your son/daughter faced any personal challenges or difficult experiences which may have affected his/her academic or emotional growth?

6. Has your son or daughter ever received any Special Education Services? Is there an active Individual Educational Plan on file at LHS? If so, do you grant me permission to include this information in my statement?

7. Is there anything else that you would like me to share in my school statement? Any anecdotes that reflect your son/daughter's uniqueness and/or personality?

8. Is it okay for the counselor to quote from your above-mentioned statements? YES NO

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January 2016, EPON