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Collegiate Concierge and Coaching - Parent Intake

The following information is collected for consulting and will be held in private by Collegiate Concierge & Coaching. Collegiate Concierge & Coaching has extensive experience in higher education ranging from prospective students still in high school to graduate and professional school applicants and is willing to provide services to students and their families based on this background. Before any services are agreed upon or commitments made by either party the following information must be provided. Following completion and receipt of information Collegiate Concierge & Coaching, LLC will follow up with the student and their family to discuss potential services and next steps.

Your Student's Name *
Please provide your student's first and last name
Your answer
Student's Date of Birth *
Your answer
First Name (Parent) *
Your answer
Last Name (Parent) *
Your answer
Street Address *
Your answer
City, State, Zip Code *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Ethnic Background *
Your answer
Highest Level of Education Completed *
Required
College/University Attended *
Your answer
College Major *
Your answer
List any extracurricular activities you were involved while in college *
Your answer
Describe your experience in while attending college/university *
(generally positive, negative, had to work hard, school came easy, etc)
Your answer
Career Information *
Describe your career
Your answer
Parent’s Take on Student’s Future *
Share with us, in your own words what your student’s goals are for a future career
Your answer
Share with us, in your own words, what your student plans on studying to help them achieve this goal (think college major) *
Your answer
Share with us where you would like your student to go to College and include back up plan Colleges/Universities. Please list the schools in your order of preference beginning with your top pick: *
Your answer
Share with us how you chose the schools your student is interested in attending and how you determined your order of preference *
Your answer
Is your child a student athlete? *
Do you plan on your child playing sports at the college level? Would it make a difference if there was a scholarship associated with them playing a sport at the college level? *
Your answer
Does your child have an Individual Educational Plan (IEP) or 504 Plan? *
Does your child work with a tutor? *
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