Student Information Sheet
Program Type *
First Name of Student *
Last Name of Student *
Preferred Name (if different from first name)
Mailing Address *
Does this student have citizenship in any country besides the United States? If so, which country?
Student Cell Phone#
Student Email *
Student SkypeID
Student WhatsApp UserID (if any)
Student WeChat UserID (if any)
Name of Current School *
Expected Graduation Year *
Name of Guidance Counselor
Names of Teachers Writing Recommendation Letters (list up to 3)
Most Recent SAT Score (if applicable)
Date SAT Taken (approximate)
MM
/
DD
/
YYYY
Most Recent ACT Score (if applicable)
Date ACT Taken (approximate)
MM
/
DD
/
YYYY
Have you used (or are you currently using) a test tutor? If so, who is your tutor?
Household Status of Parents
Clear selection
Name of Parent/Guardian #1 *
Phone Number of Parent/Guardian #1 *
Email of Parent/Guardian #1 *
Name of Parent/Guardian #2 (if applicable)
Phone Number of Parent/Guardian #2
Email of Parent/Guardian #2
Name of Parent/Guardian #3 (if applicable)
Phone Number of Parent/Guardian #3
Email of Parent/Guardian #3
If you have any preferred colleges you know you are considering, please list them here
If you have identified any "safety" schools you expect to apply to, please indicate them here
Indicate if you are interested in a particular major/concentration or program
Although your work with UCA is not intended to be meeting-intensive, students do need to be available for periodic meetings during regular business hours to complete Guided Self-Analysis work and keep on pace with application work. Please let us know if there are particular days or times that are particularly good or bad for your student to meet.
Is there any other information we should know before we begin work with your student?
SPID (for internal use only, please do not edit)
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