Advanced College Counseling
NEW STUDENT QUESTIONNAIRE
STUDENT INFORMATION:
*
Indicates required field
Student Name
*
First
Last
GRADUATING CLASS
*
2022
2023
2024
2025
2026
2027
Student Mobile Number
*
MOBILE NUMBER
Student Email
*
Student Home Number
*
HOME NUMBER
Date of Birth
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
MOTHER'S INFORMATION:
Mother's Name
*
First
Last
Mother's Mobile
*
MOBILE NUMBER
Mother's Email
*
Mother's Address
*
Line 1
Line 2
City
State
Zip Code
Country
If different from student.
HIGHEST LEVEL OF EDUCATION COMPLETED
*
Elementary
Some High School
High School Degree
Some College
2 Year College Degree
4 Year College Degree
Graduate School Degree
COLLEGE & MAJOR
*
GRADUATE SCHOOL & DEGREE
*
CURRENT OR PREVIOUS PROFESSION
*
EMPLOYER
*
FATHER'S INFORMATION:
Father's Name
*
First
Last
Father's Mobile
*
MOBILE
Father's Email
*
Father's Address
*
Line 1
Line 2
City
State
Zip Code
Country
If different from student.
HIGHEST LEVEL OF EDUCATION COMPLETED
*
Elementary
Some High School
High School Degree
Some College
2 Year College Degree
4 Year College Degree
Graduate Degree
COLLEGE & MAJOR
*
GRADUATE SCHOOL & DEGREE
*
CURRENT OR PREVIOUS PROFESSION
*
EMPLOYER
*
SIBLINGS:
SIBLING/S NAME, AGE, HIGH SCHOOL GRADUATION YR.
*
List all siblings, age & current school, if applicable.
ADDITIONAL INFORMATION:
DISABILITIES, LEARNING DIFFERENCES, 504/IEP?
*
List all learning differences & disabilities (family & student). Do you have a 504 or IEP?
STUDENT'S RELIGION & POLITICAL PARTY
*
STUDENT LIVES WITH:
*
Father
Mother
Stepmother
Stepfather
Guardian
Other
Please check all that apply.
LGBTQ+
*
N/A
Lesbian
Gay
Bisexual
Transexual
Queer
Intersex
Asexual
Other
CHECK ANY THAT APPLY:
*
Father deceased
Mother deceased
Parents divorced
Parents separated
Father remarried
Mother remarried
Do you plan to apply for financial aid?
*
Yes
No
Maybe
HIGH SCHOOL INFORMATION:
HIGH SCHOOL
*
HIGH SCHOOL COUNSELOR
*
GPA UNWEIGHTED
*
GPA WEIGHTED
*
UC 10TH/11TH GPA
*
CLASS RANK
*
PSAT SCORE & DATE
*
ENTER TOTAL SCORE, CRITICAL READING SCORE, MATH SCORE & WRITING SCORE + DATE TAKEN
SAT SCORES & DATES
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LIST READING, MATH & WRITING + TOTAL SCORE AND DATE TAKEN AND IF ADDITIONAL TESTS ARE PLANNED
ACT SCORES & DATES
*
LIST DATE/S TAKEN + ENGLISH, MATH, READING, SCIENCE, WRITING & TOTAL
AP CLASSES AND TEST SCORES
*
LIST ALL SUBJECTS, DATES TAKEN, SCORES AND ADDITIONAL PLANNED TESTS
Do you plan to take a review course for the ACT and/or SAT?
*
Yes
No
Undecided
Tutor:
*
If you are working with a tutor, please give their name.
QUESTIONNAIRE:
WHEN ANSWERING THESE QUESTIONS, PLEASE REMEMBER THAT YOU CAN CHANGE YOUR MIND AT ANY TIME OR ADD SOMETHING NEW.
What kind of college do you see yourself attending?
*
Small, private, in state, big name, large athletic program, public, liberal arts, engineering, rural, college town, city, coastal, East Coast, weather considerations, liberal, conservative, etc.
What is your greatest achievement?
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If you were a philanthropist (had money to give away), what program or cause would you support? Why?
*
List suggested search words for college matches & possible scholarships.
*
For example, possible majors, career goals, community service work, interests, religious affiliations, clubs, cultural ties, politics, disabilities, talents, arts, etc.
What are you most looking forward to in college?
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What type of career interests you?
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Where would you like to study abroad?
*
Rank the following in order of importance: College/Major/Location
*
List the most important first & the least important last.
College List:
*
Please create a list of up to 10 schools (including possible majors & any additional relevant information) that interest you.
ACTIVITIES, INTERESTS & AWARDS:
Leadership Positions
*
List all leadership positions & years of participation.
Volunteer/Community Service
*
List all volunteer/community service & years of participation.
Athletics
*
List all athletics (club sports, high school teams, etc.) & years of participation.
Music/Arts
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List all involvement with music and the arts & years of participation.
Clubs/Organizations/Religious Groups
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List all clubs, organizations, and/or religious groups that your years of participation.
Honors & Awards
*
List all honors & awards and year/s received.
Submit