Iu Jim Holland Summer Enrichment Program Counselor Form: Course/grade Verification
Download a blank fillable Iu Jim Holland Summer Enrichment Program Counselor Form: Course/grade Verification in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Iu Jim Holland Summer Enrichment Program Counselor Form: Course/grade Verification with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3Student Name: ________________________________________________________________
Last
First
Middle
Gender:
Female
Male
School Name: ______________________________________
IU J
H
S
E
P
IM
OLLAND
UMMER
NRICHMENT
ROGRAM
C
F
: C
/G
V
OUNSELOR
ORM
OURSE
RADE
ERIFICATION
The student who has provided you this form is applying for participation in the Jim Holland
Summer Enrichment Program on the Indiana University Bloomington campus. Students
being considered for participation are currently in grade 8, 9, or 10, have a sincere interest in
science and in attending college or a university, and are academically on track to do so.
They should have a minimum GPA of 3.0 (non-weighted). Please fill in PDF, print, and sign
before mailing.
PLEASE DO NOT SEND TRANSCRIPTS.
Please verify the following information about the applicant:
Student’s Full Name: ______________________________________________________
First
Middle
Last
Current Grade
: 8
9
10
Gender
: Female Male
(check one)
(check one)
GPA (non-weighted): ____ out of 4.0 Student receives free/reduced lunches: Yes No
Number of days applicant is absent from school this year
____
On the attached pages, identify the science and math courses by precise name, level, and semester
st
nd
[e.g. Algebra I (1
semester), College Preparatory Biology II (2
semester)] and record final grades
received each semester or grades to date. If a science or math course taken is not listed, include the
name, level, and semester taken in the space marked “Other”. Do not forget to record the grade
earned.
Please seal all required documents in an envelope and sign the sealed flap so that the information
remains confidential. You may return the sealed envelope to the student as soon as possible or
mail it directly to:
Indiana University Department of Biology
Attn: Jim Holland Summer Enrichment Program Selection Committee
1001 East Third Street / Jordan Hall 326
Bloomington, IN 47405-3700
deadline date of March 18, 2016
This form must be received by the
. Late forms will eliminate
the student from consideration. PLEASE DO NOT FAX OR EMAIL THIS FORM.
I verify that the GPA, course levels, grades, and attendance of this student are all correct.
_____________________________________ _(____)____________
___________________
Counselor Name (Please Print)
Phone No.
Email
_______________________________________________________
_____/ _____/ _________
Counselor Signature
Date (mm/dd/yyyy)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal