CAC Parent Intake Form

College Admission Coach,LLC Parent Intake Form
Student's Name*

First NameMiddle NameLast Name
Parent 1 Information
Parent 1 Name*

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Telephone

Area CodePhone Number
Home Email*
Cell Phone*

Area CodePhone Number
Business Name
Position
Business Telephone

Area CodePhone Number
Business Email
Parent's Undergraduate College
Parent's Graduation Year
Parent's Graduate College
Are you willing to be contacted by a College Admission Coach student who is interested in your profession? S/he would request an informational interview or a job shadow.*

YesNo
Parent 2 Information
Name

First NameLast Name
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Telephone

Area CodePhone Number
Home Email
Cell Phone

Area CodePhone Number
Business Name
Position
Business Telephone

Area CodePhone Number
Business Email
College
Graduation Year
Are you willing to be contacted by a College Admission Coach student who is interested in your profession? S/he would request an informational interview or a job shadow.

YesNo
Does the student live with both parents?

YesNo
If not, with which parent?
Please include the name and email address of the person who will be responsible for paying College Admission Coach invoices.*
How did you hear about Jodi Walder or College Admission Coach,LLC?*
Your child is completing a detailed questionnaire prior to our meeting. Your own responses and insights relating to the questions that follow will help us in our counseling efforts. Please feel free to attach any additional commentary that you think would be helpful.
Please comment on your child’s relative strengths and weaknesses as a student. Include your perspective on his or her motivation, self-discipline, energy level, organization, independence, creativity, level of self-confidence, etc.*
How would you describe your child’s personality and values? Please comment on leadership ability, maturity, concern for others, social and/or community interests, etc.*
What is his or her greatest achievement? In what sense is s/he special? In what areas does s/ he “shine”?*
Please indicate any family, medical, psychological, or special testing background that we should be aware of in order to effectively counsel your student in the college selection process. Our contract requires you to disclose this information to us; however, it will be discussed and agreed upon whether or not this information is disclosed to colleges during the application process.*
Are there any adverse conditions your child has had to overcome to achieve the level of competence s/he currently has?*
What characteristics are you especially interested in finding in a college or university for your child? You might want to comment on type, size, atmosphere, facilities, location, academic programs, challenge, or level of competitiveness.*
List the names of colleges or universities to which you would encourage your child to apply.*
Are you open to the possibility of your student taking a planned gap year between high school and college.*

YesNo
If you wish to add anything not covered above, please feel free to elaborate.
College Costs and Financial Aid

How important is the cost of the college your child ultimately attends?*

	1	2	3	4	5

1 is Imperative, 5 is Not Important

In constructing your student’s college list, how important is it that we search for tuition discounts (merit aid) for your student?*

	1	2	3	4	5

1 is Imperative, 5 is Not Important

Have you had a discussion with your student about how the college costs are going to be taken care of? If so, please fill me in on the discussion. If not, when will this discussion take place?*
Are you willing to complete some simple online price calculators to determine estimated costs to your family? If so, here is a place to start: https://bigfuture.collegeboard.org/pay-for-college/paying-your-share/expected-family-contribution-calculator*

YesNo
Assuming that you have completed cost calculators for Federal Methodology (FM) and Institutional Methodology (IM) in the link above, are you willing to share with me, your Expected Family Contribution figures for the FM and IM? Please understand that all figures are strictly confidential. I never share this information with anyone, and certainly not your child.*
Do the cost estimates align with the amount you would like to pay for college each year? If not, how much do you want to spend or will you be able to spend, per year, on your student’s college education?*
Are there sources of funds for college in your student’s name? Trusts? Savings accounts from grandparents?*
Do you want your student to carry student loans for all four years? For some of the years? How much in loan amounts do you think is reasonable?*
At any time while this student is in college, will you have another child in college?*
Should be Empty:

College Admission Coach,LLC Parent Intake Form

Parent 1 Information

Parent 2 Information

Your child is completing a detailed questionnaire prior to our meeting. Your own responses and insights relating to the questions that follow will help us in our counseling efforts. Please feel free to attach any additional commentary that you think would be helpful.

College Costs and Financial Aid