Student Intake Form

Student Information

First Name

Last Name

Phone

Email

Attending High School

High School Graduation Year

Primary Parent Contact

First Name

Last Name

Phone

Email

Secondary Contact

Optional — a second parent/guardian or another contact.

First Name

Last Name

Phone

Email

Address

Address Line 1

Address Line 2

City

State

Postal Code

Academics

Unweighted GPA

Weighted GPA

Upload Transcript

Choose File No file chosen

Accepted formats: PDF, JPG, PNG, DOC.

Standardized Testing

Have you taken the ACT/SAT yet?

Yes No

If you've taken either test, please share your scores below. Leave blank whichever test you haven't taken.

ACT

Test Date

Composite

Math

Science

English

Reading

SAT

Test Date

Composite

Reading/Writing

Math

College Interest & Info

Are there any colleges you are especially interested in?

Yes No

Please list them here

Have you gone on any campus visits yet?

Yes No

List each school you've visited and rate it: 1 = meh, 5 = I could totally see myself there.

Visit 1 – College Name

Rating

Visit 2 – College Name

Rating

Visit 3 – College Name

Rating

Visit 4 – College Name

Rating

Visit 5 – College Name

Rating

Visit 6 – College Name

Rating

Visit 7 – College Name

Rating

Visit 8 – College Name

Rating

Visit 9 – College Name

Rating

Visit 10 – College Name

Rating

Which of the following appeal to you? (Select all that apply)

Size

Small (< 2,000) Medium (2,000–9,999) Large (10,000–19,999) Very Large (20,000+)

Campus Setting

College Type

Public Private Include 2-Year Programs

Is Greek life important to you?

Yes No

Are there any school activities that are important for you?

What type of culture are you looking for? (Select all that apply)

Do you know what you would like to major in?

Totally don't know yet!

Potential Major 1

Potential Major 2

Potential Minor

Student Information

Primary Parent Contact

Secondary Contact

Address

Academics

Standardized Testing

College Interest & Info

Thank you!