Members of the Class of 2011:

Please complete the following questionnaire. Your responses will be of great help as I write
your college admission letter of recommendation. Use as many pages as you need. You
should either email or hand-deliver your completed form by August 6, 2010. Good Luck.

Name___________________________________________________________________

SS# ________________________ Date of Birth_________________________________

Street address__________________ City____________________ Zip________________

E-Mail Address ___________________________________________________________

Home Telephone Number _______________ Cell Phone Number___________________

Father’s Name: _______________________ Mother’s Name: _____________________

Colleges Attended_____________________ Colleges Attended___________________

Brothers, ages _______________________ Sisters, ages: ________________________

If older, colleges attended: _________________________________________________

If you are planning to enter college, what do you want to study?

What career field (s) are you considering? __________________________________

Please list the names of schools to which you are considering submitting applications:

______________________________________________________________________________

______________________________________________________________________________

Why have you selected these schools?

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

SERVICE: In what ways have you contributed to Lusher or the New Orleans community?

1
______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

LEADERSHIP: In which ways have you demonstrated leadership at Lusher or in the city of
New Orleans?
______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

ACADEMICS: Describe two academic experiences that have been most meaningful to you?

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

CHARACTER: Define Character? How have you lived up to your definition?

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

2
If you are involved in a Certificate of Artistry program, describe how participation has
strengthened your growth as an artist.

Ahh, the proverbial 11th grade English research paper! Name your topic, give an overview of its
thesis, and share what you learned and liked the most from the experience.

If you are either a Lusher Scholar or involved in Senior Project, describe your experiences thus
far and what plans you have for the future.

______________________________________________________________________________

3
List five adjectives you would use to describe yourself. Give specific examples of why you
choose these words?
______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Describe a personal or academic life experience that seemed negative at the time, but turned out
to be positive in the end:
______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Describe a personal or academic experience that required resiliency on your part:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Describe your summer experiences after ninth, tenth and eleventh grades:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Looking back over your high school career, what are the influences (family, friends, school etc)
that have shaped you as a student/person? If possible, give specific examples.

4
______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Describe an academic experience when you demonstrated academic curiosity, an occurrence

where you dug deeper and did much more than the assignment.
______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Is your high school record an accurate measure of your ability and potential? Have there been
circumstances, personal or academic, that have interfered with your academic performance

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

What do you consider your greatest strength, special talent or personal quality?

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

What do you consider your most troublesome weakness?

5
______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

What are you most looking forward to in college?

Is there anything else you’d like the College Counselor to know about you that not covered in

this questionnaire?