Counselor Form

Counselor Use Only Form

Project SEARCH Student Applicant's Name:

First Last

School of Residence:

Total Credits to Date:

Cumulative GPA:

Has the student met high school completion requirements?

Yes

Attendance: Days Absent - Grade 11:

Times Tardy - Grade 11:

Attendance: Days Absent - Grade 12:

Times Tardy - Grade 12:

Comments about Attendance:

Reporting Counselor's Name:

First Last

Arrangements must be made to defer the High School Diploma/Certificate of Attendance. Has this been completed?

Yes

Comments:

Counselor's Name:

First Last

Date

Please confirm:

I certify that the above facts are true to the best of my knowledge.

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