Post-Secondary Counseling Initial Intake Form
By completing this survey, you are providing our office with valuable information that will serve as a foundation for our conversations about your plans for life beyond high school.
General Information
Student Name
*
First Name
Last Name
Preferred Email
*
example@example.com
Did your parents attend college? If so, where?
*
Do you have an older sibling(s) in college or who has gone to college? If so, where?
*
How would you define success after high school?
*
For example, is it being admitted to a particular school? Making a lot of money? Having a work-life balance? Studying or doing something you love?
What are your favorite subjects?
*
Are you an athlete, artist or musician interested recruiting, auditions and/or portfolios?
*
Please specify
What do you enjoy doing in your free time?
How do you manage stress?
*
List one or two teachers you might ask for a letter of recommendation.
*
College or Post-Secondary Information
Are you interested in exploring:
*
Career-Focused Training
Professional Certificate
2-year education
4-year College Degree
I'm not sure
Have you visited any colleges/institutions/training programs? If so, please list:
*
What geographic areas are you open to exploring?
*
Rocky Mountains
Pacific Northwest
California
Northeast
Southeast
Midwest
Southwest
I prefer to stay in-state
International
I'm not sure
Would you feel comfortable applying to a school that requires you to declare your major when submitting your application?
*
Yes
No
I'm not sure
Do you plan to pursue financial aid/scholarships?
*
Yes
No
I'm not sure
Would you prefer to be a:
*
big fish in a big pond
big fish in a small pond
small fish in a big pond
small fish in a small pond
I'm not sure
In terms of size, do you think you prefer?
*
Small: under 3,000 students
Medium: 3,000-8,000
Large: 8,000-20,000
Very Large: over 20,000
I'm not sure
Are you open to faith-based colleges?
*
Yes
No
Maybe
Do you prefer large lectures or discussion-based classes?
*
1
2
3
4
5
Large lectures
Discussion-based classes
1 is Large lectures, 5 is Discussion-based classes
How important is a residential campus (vs a commuter campus) to you?
*
1
2
3
4
5
Not that important
Very important
1 is Not that important, 5 is Very important
How important is school spirit?
*
1
2
3
4
5
Not that important
Very important
1 is Not that important, 5 is Very important
How important is diversity on campus?
*
1
2
3
4
5
Not that important
Very important
1 is Not that important, 5 is Very important
How important is Greek (fraternities/sororities) life?
*
1
2
3
4
5
Not that important
Very important
1 is Not that important, 5 is Very important
How important is it that your campus be LGBTQ friendly?
*
1
2
3
4
5
Not that important
Very important
1 is Not that important, 5 is Very important
How important is it that your college be in or near a city?
*
1
2
3
4
5
Not that important
Very important
1 is Not that important, 5 is Very important
How important is it that you can access the outdoors easily?
*
1
2
3
4
5
Not that important
Very important
1 is Not that important, 5 is Very important
Would you be interested in exploring a GAP year?
*
1
2
3
4
5
Not at all
Oh yeah - very much!
1 is Not at all, 5 is Oh yeah - very much!
Submit
Should be Empty: