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.
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Your Student's Name *
Please provide your student's first and last name
Student's Date of Birth *
First Name (Parent) *
Last Name (Parent) *
Street Address *
City, State, Zip Code *
Phone Number *
Email Address *
Highest Level of Education Completed *
College/University Attended *
College Major *
List any extracurricular activities you were involved while in college       *
Describe your experience in while attending college/university *
(generally positive, negative, had to work hard, school came easy, etc)
Career Information *
Describe your career
Parent’s Take on Student’s Future *
Share with us, in your own words what your student’s goals are for a future career
Share with us, in your own words, what your student plans on studying to help them achieve this goal (think college major) *
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:       *
Share with us how you chose the schools your student is interested in attending and how you determined your order of preference *
Is your child a student athlete? *
Does your child have an Individual Educational Plan (IEP) or 504 Plan? *
Does your child work with a tutor? If yes, please share with us who they are working with. *
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