Student’s Full Name_____________________________________

Address _____________________________________

_____________________________________

Phone _____________________________________

Parents Names_________________________________________

Number of students in graduating class______________

Your rank in class _____________________________

G.P.A. _______________________________________

ACT score_____________________________________

Attendance Record: Freshman Present _____ Absent____

Sophomore Present _____ Absent____

Junior Present _____ Absent____

Senior Present _____ Absent____

What College do you plan to attend? ________________________

Have you been accepted?____________

Intended Field of Study:__________________________________

Extra Curricular Activities (Indicate year 1, 2, 3, 4)

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Offices held in school class or other (specify)

__________________________________________________________________________________________________________________________________________________________________

Awards and Honors __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What was your favorite class in High School and why?

Signature of two teachers at BCHS who recommend you.

1. _____________________________________________

2. _____________________________________________

Signature of student:___________________________________

(This template is available online at Ponderosa’s website. www.boyd.k12.ky.us

Go to school locations/websites and click on Ponderosa Elementary.)