QUESTIONNAIRE

BACKGROUND QUESTIONNAIRE
DIRECTIONS: PLEASE FILL OUT THIS STUDENT QUESTIONNAIRE. QUESTIONS 5-12 HAVE FOUR POSSIBLE ANSWERS. IT'S NOT NECESSARY TO FILL IN ALL FOUR CHOICES.
1. NAME:
2. AGE:
3. HIGH SCHOOL GRADUATED FROM:
4. IF YOU HAVE A GED PLEASE INDICATE WITH A YES OR NO:
5. YOUR MAJOR SHORT-TERM GOALS:
5a.
5b.
5c.
5d.
6. YOUR MAJOR LONG-TERM GOALS:
6a.
6b.
6c.
6d.
7. SUBJECT(S) YOU MAY WANT TO PURSUE AS YOUR COLLEGE MAJOR:
7a.
7b.
7c.
7d.
8. SUBJECTS YOU FOUND MOST INTERESTING IN HIGH SCHOOL:
8a.
8b
8c.
8d.
9. YOUR PERCEIVED GREATEST STRENGHTS OR ASSETS:
9a.
9b.
9c.
9d.
10. EXTRACURRICULAR ACTIVITIES YOU WERE INVOLVED IN HIGH SCHOOL
10a.
10b.
10c.
10d.
11. FUN THINGS YOU ENJOY DOING:
11a.
11b.
11c.
11d.
12. COLLEGES/UNIVERSITIES YOU ARE INTERESTED IN ATTENDING:
12a.
12b
12c.
12d.
13. PLEASE STATE WHY GOING TO COLLEGE IS IMPORTANT TO YOU:
14. WHAT ABOUT YOU DO YOU WANT TO MAKE BETTER AS A RESULT OF GOING TO COLLEGE?
15. IS THERE ANYTHING THAT MAKES YOU DIFFERENT FROM OTHERS GOING TO COLLEGE?
16. YOU HAD A UNIQUE EXPERIENCE OR EXPERIENCES THAT HAVE IMPACTED YOUR LIFE?
Should be Empty:

BACKGROUND QUESTIONNAIRE