Counselor’s Student Information Form Student's Name(Required) First Middle Last Number in Graduating Class(Required)Approx Class Rank (%)(Required)Year to Graduate(Required)Grade Point AverageBased on A-4, B-3, C-2, D-1.Weighted:(Required)Unweighted:(Required)Test ScoresSAT (Math)(Required)SAT (Verbal)(Required)ACTGATBASVBFlorida Test ScoreOther test score(s) (Please state name and score):Academic courses takenPlease indicate number of credit hours carried each school year1st Year(Required)2nd Year(Required)3rd Year(Required)4th Year(Required)Attendance Record(Required) Good Average Poor Recommendation of Counselor(Required) Yes No Upload TranscriptAccepted file types: pdf, Max. file size: 1 GB. Please provide any other information you deem noteworthy concerning the applicant.Consent(Required) I agree.We request that this form be completed by a duly authorized representative of the school and retained in the school office until the student submits his/her completed application. This questionnaire along with the student’s application must be returned to the Ellison McCraney Ingram Foundation Scholarship Committee, no later than December 1st of each year.Signature(Required)
