2010-11 International Supplement IS

For Spring 2011 or Fall 2011 Enrollment

You may leave all school contact information (at the bottom of this page) blank if you are stapling this International Supplement to the
Secondary School Report before mailing. Please type or print in black ink. Check specific college information in our Requirements Grid or
online to ensure a member institution uses this form. This form should only be completed by secondary schools using non-US educational
systems. International schools using an AP curriculum exclusively need not complete this form.

to the applic ant

p Female
Legal Name ___________________________________________________________________________________________________________________
p Male
Last/Family/Sur (Enter name exactly as it appears on official documents.) First/Given Middle (complete) Jr., etc.

Birth Date __________________________________________________________________ Social Security # _____________________________________

mm/dd/yyyy (Optional)

Address ______________________________________________________________________________________________________________________
Number & Street Apartment # City/Town State/Province Country ZIP/Postal Code

School you now attend ________________________________________________________ CEEB/ACT Code _____________________________________

TO THE secondary school counselor

What is the primary language of instruction in your secondary school? ______________________________________________________________

_____
________
Is promotion within your educational system based upon standard examinations (for example: Abitur, GCSE/A-Level, ICSE/ISC, etc.) given at the end of lower and/or
senior secondary school by a state or national examinations board? p Yes p No

If yes: Please attach an official copy of this student’s lower secondary examination results. If the student has already taken senior secondary leaving exams, please
include an official copy of the results. If this applicant’s senior secondary leaving exam results are not yet available, please indicate predicted results on the reverse.
If you have already forwarded these results with the Secondary School Report, you do NOT need to attach another copy to this form.

If no: Please attach an official transcript of this student’s academic record for the final three years of secondary school, including courses taken and marks/grades in
those courses. If you have already forwarded a full transcript with the Secondary School Report, you do NOT need to attach another copy to this form.

Senior secondary leaving examinations

Date of exam (month/year) Examining board Academic subject Predicted result Actual result

Overall result

Please indicate the marking or grading scale used in your school and its approximate equivalence to the A-F scale commonly used in the United States:
A (Excellent) __________ B (Very Good) __________ C (Average) __________ D (Poor) __________ F (Failing) __________

Counselor’s Name (Mr./Ms./Dr., etc.) ________________________________________________________________________________________________

Please print or type

Signature _________________________________________________________________________________________________ Date _____________________

mm/dd/yyyy

Title ______________________________________________________ School _____________________________________________________________

School Address _________________________________________________________________________________________________________________

City/Town State/Province Country ZIP/Postal Code

Counselor’s Phone (_______) _________________________________________ Counselor’s Fax (_______) __________________________________________

Area Code Number Ext. Area Code Number

Secondary School CEEB/ACT Code ___________________________ Counselor’s E-mail _________________________________________________________

© 2010 The Common Application, Inc. IS-1/ 2010-11