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Activities Questionnaire

Seniors are asked to complete this form which is helpful to advisors, class deans and other college officials when considering recommendations, prize competitions and other academic or program opportunities.

Note: You must be sure your questionnaire is as complete as possible before submitting. You cannot return to the questionnaire for completion at a later date. Information marked with * is required.  Please complete form BEFORE February 10, 2008 to ensure full consideration of submitted information.

Student Information

Last Name *
 First Name *
 Middle
DID *

Extracurricular Activities

On-Campus

What are the on-campus groups and organizations in which you have been involved at Dartmouth?
*(at least one activity is required to be listed below)

Groups/Organizations/Activities Leadership Roles Terms Participated/
Hours per week		 Paid?
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N

Explain which item above is the most significant On-campus activity, and why:

Off-Campus

What activities have been your most significant Off-campus activities? (e.g. Headrest, DHMC, Big Brother/Big Sister, etc.)

Groups/Organizations/Activities
 Leadership Roles Terms Participated/
Hours per week		 Paid?
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N
Y N

Explain which item above is the most significant Off-campus activity, and why:

Academic Achievements

How have you gone beyond the required academic standard at Dartmouth, in any way?

  • Honors, Awards, Scholarships:
  • Research, Teaching Assistant Positions:
  • Independent Studies, Senior Thesis:
  • Publications, Conferences:
  • Citations:

What has been the most valuable experience in your Dartmouth Education?

Employment

List any jobs, work-study or other, that you have had during your Dartmouth career, and indicate how long you held each position:

Employment Term

Explain which item above is the most significant Employment activity, and why:

Off-Terms

What have you done during your off terms? Foreign Study Programs? Research? Worked in a bookstore in your hometown? A community service project in Costa Rica? How have they supplemented your Dartmouth education?

Off-Term Activity Term

Which one was most significant and why?

Awards

Are there any awards or programs for which you have applied that are pending at this point?

Other

Is there something else that has significantly marked your Dartmouth career that does not fall into any of these categories? Write about it!

Future

What are your future plans, dreams?

Submit your Questionnaire

Note: You must be sure your questionnaire is as complete as possible before submitting. You cannot return to the questionnaire for completion at a later date.

 

Last Updated: 1/4/08