STUDENT FACT SHEET

(Please fill out this form to request a letter of recommendation for the Common App, private schools, and/or scholarships)

Common App
 School Information:
o Address: 1101 Eucalyptus Drive, San Francisco, 94132
o Phone: (415) 759-2730
 Adding Your Counselor as a Recommender:
o MY COLLEGES  RECOMMENDERS AND FERPA  COMPLETE RELEASE AUTHORIZATION
 Please waive your rights to review recommendations and sign  INVITE COUNSELOR
 Application guide for first-time students: https://www.commonapp.org/apply/first-time-students

The last day to add Your Counselor as a recommender on the Common App and return your Fact Sheet to Your
Counselor is ________________, 2020. If you are applying early please return this by ________________, 2020.

FULL NAME ______________________________________________________________ REG __________________

Select all that apply:

 You will be the 1st person to attend college in the U.S. in your immediate family
 You have received or are eligible to receive an ACT or SAT testing fee waiver
 You are enrolled in or eligible to participate in the Federal Free or Reduced Price Lunch program (FRPL)
 Your annual family income falls within the Income Eligibility Guidelines set by the USDA Food and Nutrition
Service
 You are enrolled in a federal, state, or local program that aids students from low-income families (e.g., TRIO
programs such as Upward Bound)
 Your family receives public assistance
 You live in a federally subsidized public housing, a foster home or are homeless
 You are a ward of the state or an orphan
 Optional: You can provide a supporting statement from a school official, college access counselor, financial aid
officer, or community leader to further support/explain your financial needs

Briefly answer the following (note: this is the time to brag about yourself!):
1. Write about a time you were confident, motivated, and persevered through challenges/failures.

2. How have you shown maturity, responsibility, initiative, and a concern for others?

3. How do you think the school and the outside community perceives you?
Briefly answer the following:
 Do you feel that your courses, grades, and test scores accurately represent your academic potential? Why?

 What area(s) are you considering for your college major or career interest?

1. _________________________ 2. _________________________ 3. _________________________

 List 6 adjectives that you believe (or someone who knows you well) describes you?

1. ___________________________________ 2. ___________________________________
3. ___________________________________ 4. ___________________________________
5. ___________________________________ 6. ___________________________________

 What extracurricular activity or community service was most meaningful to you? Why? How did it impact your
life?

 In order of priority, importance, or commitment:

Extracurricular Activities School Year(s) Position & Responsibilities

Sport(s), Talent(s) [9, 10, 11, 12]

Community Service/Clubs School Year(s) Description/Responsibilities

Employment School Year(s) Hours/Week Responsibilities/Earnings