Student College Counseling Questionnaire
This questionnaire is for students in the second half of 10th grade and beyond.
Student's Info
Full Name
*
First Name
Middle Name
Last Name
Nickname
Pronouns
Date of Birth
*
/
Month
/
Day
Year
Date Picker Icon
E-mail
*
example@example.com
Cell Phone Number
*
Home Phone Number
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Current high school
*
High school graduation year
*
Did you attend any other high schools?
Please Select
Yes
No
Which other high school(s), and in which grade(s)?
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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 Name
Last Name
Parent/Guardian #1: Cell
*
Parent/Guardian #1: E-mail
*
example@example.com
Is this person's address the same as yours?
Please Select
Yes
No
Parent/Guardian #1: Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
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 Name
Last Name
Is this person's address the same as yours?
Please Select
Yes
No
Parent/Guardian #2: Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
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.
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Standardized Testing
PSAT 10: Reading & Writing Score
PSAT 10: Math Score
PSAT 11: Reading & Writing Score
PSAT: Math Score
SAT Reasoning Date
-
Month
-
Day
Year
Date Picker Icon
Reading & Writing Score
Math Score
SAT Reasoning Date
-
Month
-
Day
Year
Date Picker Icon
Reading & Writing Score
Math Score
ACT Date
-
Month
-
Day
Year
Date Picker Icon
Composite
English
Math
Reading
Science
ACT Date
-
Month
-
Day
Year
Date Picker Icon
Composite
English
Math
Reading
Science
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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)?
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Your College Preferences
Remember, the more open-minded you are, the more options you will have!
What size schools would you consider?
*
Small (1,000 to 4,000 students)
Medium (4,000 to 10,000 students)
Large (10,000 students or more)
What regions would you consider?
*
Northeast
Southeast
Mid-Atlantic (beyond the DC area)
Washington Area (DMV, Baby!)
Midwest
Southwest
West
Other Countries
What settings would you consider?
*
Urban (I like tall buildings.)
Suburban (I like neighborhoods.)
Rural (I like cows.)
Are you interested in "specialty" schools?
*
Music conservatory
Art school
Women's College
HBCU (Historically Black College or University)
None
Please list all colleges you're interested in.
*
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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?
*
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