Vinik EPS Student Questionnaire

Address *

Parent/Guardian #1: Address

Parent/Guardian #2: Address

Parent/Guardian #2: Cell

- Area Code Phone Number
Parent/Guardian #2: Home Phone

- Area Code Phone Number
Parent/Guardian #2: Work Phone

- Area Code Phone Number
Parent/Guardian #2: E-mail
example@example.com
Parent/Guardian #2: Employer
Parent/Guardian #2: College Attended
Degree
Graduation Year
Parent/Guardian #2: Graduate School Name
Degree
Graduation Year
Parent/Guardian #2: Additional Graduate School Name
Degree
Graduation Year
If you have siblings, please list their names; ages; high school attended; college attended (if any)

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? *

Yes No
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? *

Yes No
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