ACTIVITIES AND ACHIEVEMENTS

STUDENT NAME: ___________________________________________________________

Last Name First Name Middle Name
Form 3
EXCHANGE PROGRAMS DATES (month and year) CITY, STATE TYPE OF PRORAM
(INCLUDE SPONSORS) OR FROM: TO: AND COUNTRY
LIVING OUTSIDE YOUR COUNTRY
(continue on other side)
Example: School Exchange Nov. 2013 - Dec. 2013 Munich, Germany Cultural
SECTION 1: For the following questions, you may include clubs, organizations you are a member of, sports, scouts, religious or youth groups,
volunteering, social activities, special training or hobbies (such as music, dance, drama, foreign language), and work experience. Include only those activities
you have been involved in during the last three years. See the example on the first line and write your activities the same way.
Example: City English Language Olympiad School No. 140 2013
NAME OF INSTITUTION DATE RECEIVED
SECTION 2: List any awards or prizes you have received and any significant achievements for which you have been recognized. Please indicate the dates you
received the awards or special recognition and the name of the institution giving the award. Examples include prizes, honors, medals or olympiads in areas such
as foreign language, creative writing, science, or music. List leadership positions you have held.
ACHIEVEMENTS, AWARDS AND LEADERSHIP POSITIONS
DURING A TYPICAL WEEK, WHAT ACTIVITIES DO YOU PARTICIPATE IN OUTSIDE OF SCHOOL?
Example: Basketball 5 hours per week 2013-2014
Weekly Activity Hours each WEEK
Dates of Activity
(from-to)
WHAT ACTIVITIES DO YOU REGULARLY PARTICIPATE IN, BUT NOT ON A WEEKLY BASIS?
Activity Hours each MONTH
Dates of Activity
(from-to)
WHICH ACTIVITY IS YOUR FAVORITE? WHY?
SECTION 3: If you have traveled on any international exchange programs or have lived outside your country, list in this section.
Aerobics/Shaping _______________
Badminton _______________
Basketball _______________
Bicycling _______________
Boating _______________
Cricket _______________
Football (Soccer) _______________
Gymnastics _______________
Hiking _______________
Hockey _______________
Horseback Riding _______________
Ice-Skating _______________
Mountain/Rock Climbing _______________
Roller-Skating/Roller-Blading _______________
Running/Jogging _______________
Skateboarding _______________
Skiing _______________
Snowboarding _______________
Swimming _______________
Table Tennis _______________
Tennis _______________
Track and Field _______________
Volleyball _______________
Weightlifting _______________
Wrestling _______________
Other: _______________
Other: _______________
Other: _______________
Acting (Drama/Theater) _______________
Art _______________
Astronomy _______________
Auto Mechanics _______________
Ballet _______________
Ballroom Dancing _______________
Camping _______________
Cars _______________
Ceramics/Pottery _______________
Chess _______________
Classical Concerts _______________
Computers _______________
Cooking _______________
Crafts _______________
Current Events/Politics _______________
Debates _______________
Environmental Issues _______________
Fishing _______________
Forestry _______________
Gardening _______________
Hunting _______________
Indoor Plants/Flowers _______________
Interior Design _______________
Knitting/Sewing _______________
Listening to Classical Music _______________
Listening to Pop Music _______________
Modern Dancing _______________
Movies _______________
Museums _______________
Opera _______________
Painting/Drawing _______________
Pets _______________
Photography _______________
Pop Concerts _______________
Playing Cards _______________
Playing Musical Instrument(s) _______________
Reading _______________
Religious Activity _______________
School Clubs _______________
Scouting _______________
Singing (in Choir) _______________
Sporting Events _______________
Stamp Collecting _______________
Television/Video _______________
Theater _______________
Travel _______________
Tutoring/Teaching _______________
Video Games _______________
Writing _______________
Writing Letters _______________
Other: _______________
Other: _______________
Other: _______________
ACTIVITIES AND ACHIEVEMENTS
Place an X in the box next to any sports, interests, or hobbies in which you have participated in the last three years.
Then write how many hours per week you participate in this activity, during the sports season.
Answer truthfully. You may be expected to participate in these activities in the United States.
SECTION 4
SPORTS HOURS PER WEEK SPORTS HOURS PER WEEK
INTERESTS/HOBBIES HOURS PER WEEK INTERESTS/HOBBIES HOURS PER WEEK