Mater Dei High School
1202 W. Edinger Ave.
Santa Ana, CA 92707
COUNSELOR SECONDARY SCHOOL REPORT FORM
TO THE STUDENT APPLICANT
After completing Section I, give this form to your academic counselor. You also need to provide her with envelopes addressed to each
college you are applying to with Mater Dei’s address as the return address. There should be two stamps on every envelope.
SECTION I (to be completed by student)
Legal Name: Female Male
Last/Family First Middle Jr., etc.
(exactly as it appears on official documents)
Birth Date: Social Security #:
Number & Street Apartment # City/Town State Zip/Postal Code
Email Address: Phone #:
School you now attend: Mater Dei CEEB Code: 053-240
I am applying for Early Decision Early Action Regular Decision Other:
Current year courses ---- please indicate course title and level (if AP or honors). Each semester class is 5 credits.
First Semester Second Semester
* Religion classes are mandatory all four years.
IMPORTANT PRIVACY NOTE: By signing this form, I authorize all schools that I have attended to release all requested records covered under the Federal Educational
Rights and Privacy Act (FERPA) so that my application may be reviewed by the institution(s) to which I am applying. I further authorize the admissions officers reviewing
my application, including seasonal staff employed for the sole purpose of evaluating applications, to contact officials at my current and former schools should they have
questions about the school forms submitted on my behalf.
I understand that under the terms of the FERPA, after I matriculate I will have access to this form and all other recommendations and supporting documents submitted by
me and on my behalf, unless at least one of the following is true:
1. The institution does not save recommendations post-matriculation (contact the college admissions office for information regarding their policy).
2. I waive my right to access below, regardless of the institution to which it is sent:
Yes, I do waive my right to access, and I understand I will never see this form or any other recommendations submitted by me or on my behalf.
No, I do not waive my right to access, and I may someday choose to see this form or any other recommendations or supporting documents submitted by me or on
my behalf to the institution at which I’m enrolling, if that institution saves them after I matriculate.
Required Student’s Signature__________________________________________________________ Date ____________________
SECTION II (to be completed by the academic counselor)
Mrs. Kellie Bauer – Director of Guidance & Counseling Email: firstname.lastname@example.org
Phone #: 714-850-9567 Fax #: 714-557-5885
Signature ______________________________________________________________ Date ________________________________
Cumulative GPA ______________ on a 4.0 scale covering _____________________________________ weighted unweighted
“+” or “-“ grades are not issued Passing grade is a “D” Graduation Date: May 28, 2011
Class Size : 515 Highest GPA in class: 4.65 Given our highly competitive curriculum, Mater Dei does not rank students.
Percentage of graduating class immediately attending four-year institutions: 75.1% attending two-year institutions: 23.9%
# of AP courses offered: 16 # of honors courses offered: 16
School policy limits the number of AP and honors classes students may take based on stringent course prerequisites and placement testing.
Specific course requirements are listed on the Mater Dei College & Career Planning website: www.materdei.org/ccrc.
Advanced Placement Course criteria – Students must be recommended for these courses by their Art, English, Foreign Language, Math, Science, or
Social Studies teachers. Students must also meet course prerequisites, pass the appropriate placement exams and have the approval of
the respective department chair.
Honors Course criteria – Admission varies among the departments. All departments require specific course prerequisites. Some also require a
placement test, a specific academic GPA, summer assignments, participation in science or art fairs, entrance exam scores in specific subjects,
or department chairs’ approval. Students must maintain “B” grades to remain in the subject.
In comparison to other students at our school, the applicant’s course selection is:
most demanding very demanding demanding average below average
The applicant compared to other students in his or her class year:
Below average Average Very good Excellent One of the top few ever
*Counselors do not have access to students’ discipline records.
For additional information about the student, complete curriculum grading, testing, accreditation, and college placement, please refer to
the following enclosed documents:
The Counselor Letter of Recommendation
The annual School Profile
The student’s current transcript
An online copy of the school profile and other information pertinent to college admissions representatives can be found on the Mater Dei
College and Career Planning website: www.materdei.org/ccrc.