Student College Counseling Questionnaire

Parent/Guardian and Sibling Info

You will probably need to get some of this info from your parents/guardians.
Parent/Guardian #1: Full Name*

First NameLast Name
Parent/Guardian #1: Cell*
Parent/Guardian #1: E-mail*
example@example.com
Is this person's address the same as yours?
Parent/Guardian #1: Address

Street Address

Street Address Line 2

CityState

Zip Code
Parent/Guardian #1: Employer*
Parent/Guardian #1: College Attended
Degree & Graduation Year
Parent/Guardian #1: Grad School Name
Degree & Graduation Year
Parent/Guardian #1: Add'l Grad School
Degree & Graduation Year
Parent/Guardian #2: Full Name

First NameLast Name
Is this person's address the same as yours?
Parent/Guardian #2: Address

Street Address

Street Address Line 2

CityState

Zip Code
Parent/Guardian #2: Cell
Parent/Guardian #2: E-mail
example@example.com
Parent/Guardian #2: Employer
Parent/Guardian #2: College Attended
Degree & Graduation Year
Parent/Guardian #2: Grad School Name
Degree & Graduation Year
Parent/Guardian #2: Add'l Grad School
Degree & Graduation Year
If you have siblings, please list their names; ages; high school attended; college attended (if any). If they have not yet graduated from high school, please include their anticipated high school graduation year.

Getting to Know You...
What are your favorite subjects?*
What subjects might you like to study in college?*
What is your favorite book, and why?*
Are you fluent in a foreign language?*

YesNo
What language(s)?*
What has been your most rewarding academic experience in the past year or so?*
How do you learn best (i.e., large classes, small classes, labs)?*
Have you worked to your potential in high school? Please explain.*
Are there circumstances that have interfered with your academic performance in high school (i.e., learning disabilities)? If so, explain. *
Have you been subject to disciplinary action, such as suspension, in high school? If so, explain.*
What adjectives would your best friend use to describe you?*
What would you most like a college admissions committee to know about you?*
Are you interested in playing varsity sports in college?*

YesNo
What sport(s)?

Schoolyear Activities and Experiences

Please list all of your high school extracurricular activities, including sports, clubs, drama, community service, jobs, and anything else of importance. Be sure to note both in-school and out-of-school activities, as well as any leadership positions you might have held. Please also note your time commitment to these activities.
9th Grade*
10th Grade*
11th Grade*
12th Grade (anticipated)*
Which activity or activities are most important to you, and why?*
Summer Activities and Experiences

Please describe how you have spent your recent summers, and describe your time commitment, when relevant.
Summer after 8th grade*
Summer after 9th grade*
Summer after 10th grade*
Summer after 11th grade (if you know)
Which of these experiences have been particularly meaningful to you?*
Should be Empty:

College Counseling