2022 End of the Year Survey
All fields are required.
1. Name:
*
First Name
Last Name
2. Email Address:
*
example@example.com
3. Mailing Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
4. Today's Date:
-
Month
-
Day
Year
Date
5. Name of your Marcy Scholarship Fund Mentor:
Spring 2022 ACADEMIC PERFORMANCE
6. Indicate your enrollment status during the Spring 2022 semester:
Full Time
Part Time
Not Enrolled
7. How did you do at school? Please provide your enrollment and grades for Spring 2022. Please insert all information on one row if you only attended one school during the Spring 2022 term. Only use additional rows if you attended more than one school.
School
Attempted Credit Hours
Completed Credit Hours
GPA
Indicate FT for Full Time or PT for Part Time
8. Did you fail any classes?
Yes
No
9. Did you withdraw from any classes?
Yes
No
10. Did you take any remedial coursework?
Yes
No
11. Is there anything else you want to tell us about school or your last semester?
0/100
Answer question 12 only if you were enrolled Part Time for the Spring 2022 semester.
12. If you were enrolled Part Time for the Spring 2022 semester, please explain in detail the reason for enrolling in school part time. (100 word limit)
0/100
Answer question 13 only if you were not enrolled for the Spring 2022 semester.
13. If you were not enrolled, please explain in detail the reason for not enrolling. (100 word limit)
0/100
CUMULATIVE ACADEMIC PERFORMANCE
(This section asks about the results of ALL completed terms)
14. Cumulative GPA:
15. Cumulative Credit Hours:
NEXT YEAR'S PLAN
(This section asks about your enrollment plans and how much of your degree you have completed. We want this information to help you understand what you need to do to complete your degree or program.)
16. What degree are you pursuing?
Bachelors
Associates
Other
If other, please state what type of degree:
17. In what school will you be enrolled for the Fall 2022 semester?
18. What is your major area of study?
Progress Towards Degree
19. How many credit hours are needed for your degree?
20. How many credit hours do you still need to complete before you can graduate with your degree?
21. Expected Graduation:
-
Month
-
Day
Year
Date Picker Icon
Upcoming Plans
22. What is your planned enrollment for the Fall 2022 semester?
Full Time
Part Time
23. How many credit hours do you plan to take during Fall 2022 semester?
24. Do you anticipate you will need to take any remedial coursework this semester?
25. If funding was available for tutoring, for which class (or classes) would you use a tutor?
26. Please indicate any where assistance may be helpful. (Check all that apply):
Identifying college resources
Financial aid / FAFSAS
Working on Campus
Opening a checking account
Investing in the Stock Market
Other
27. If you are enrolling as a Full Time student for the Fall 2022 semester, is there anything else you want to tell us about school or your plans?
Answer item 28 only if you plan to enroll as a Part Time student for the Fall 2022 Semester.
28. If you plan to enroll as a Part Time student for the Fall 2022 semester please provide a detailed rationale for that decision. (100 word limit)
0/100
29. Do you have plans to re-enroll in the future?
Yes
No
Answer question 30 only if you do not plan to enroll for the Fall 2022 Semester.
30. If you do not plan to enroll for the Fall 2022 semester, please provide a detailed rationale for that decision. (100 word limit)
0/100
SITUATIONAL INFORMATION
(The following questions will help us gain a better understanding of your situation and additional ways to assist in your success)
31. What are your plans for Summer 2022?
32. Are you planning to work when classes are in session?
Yes?
No?
33. Do you have any family/personal circumstances that will affect your ability to perform/stay focused as a full-time student?
Yes?
No?
If yes, please elaborate:
Your Academic Advisor’s Information
34. Name:
First Name
Last Name
Contact Information for Your Academic Advisor (provide at least one)
35. Email:
example@example.com
36. Phone Number:
Please enter a valid phone number.
Keeping In Touch
37. Your Email Address:
example@example.com
38. Your Cell Phone:
Please enter a valid phone number.
39. What is the best way to contact you?
Email?
Text Message?
40. Do you have a LinkedIn account?
Yes
No
If yes, please provide your LinkedIn name:
SCHOOL YEAR REVIEW
41. Please review your school year. Discuss any challenges, successes or obstacles you encountered. (200 word limit)
0/200
42. Please upload the following to
info@marcyscholarship.org
Transcript (with grades) for the 2021-2022 academic year
Class schedule for Fall 2022
Proof of residency in the Marcy Houses
Adapted from GradSnapp
YOU MAY SUBMIT YOUR APPLICATION NOW OR SAVE IT AND RETURN TO IT LATER. YOU WILL NOT BE ABLE TO MAKE CHANGES ONCE YOU PRESS SUBMIT.
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