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) ACT GATB ASVB Florida Test Score Other 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 Counselour(Required) Yes No 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)
