Personal Data:
Student Name
________________________________________________
Address
_____________________________________________________
City, State, and Zip Code________________________________________
Phone Number
________________________________________________
High School
__________________________________________________
(To be filled in by judge)
Non-Weighted GPA: __________ _____
ACT __________ _____
Class Rank and students in class __________ _____
SVC/SIA Sponsored Activities: __________(number of activities) _____
Total All Years (Athletic Teams, Scholastic Bowl, Honor Chorus, etc.)
On a separate sheet of paper please list all the Conference activities in which you have participated and the years of the participation.
Non-conference Activities __________(number of activities) _____
Total All Years (musical, plays, tutoring, Honor Society, etc.) On a separate sheet of paper please list all the non-conference school activities in which you have participated and the years of the participation.
Two Teacher Recommendation Letters _____ _____
Principal’s
Verification Signature _________________________________
Total Possible Points 60 points Total Points Earned ____________