Collegiate Concierge and Coaching Intake Form - Student
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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First and Last Name *
Birth Date *
Phone number *
Email address *
Address *
City, State, and Zip Code *
High School *
Current Grade *
Current GPA *
Expected High School Graduation Date (i.e.June 2016) *
Are you a student athlete? *
List your current class schedule *
List previous courses completed including grades *
(Example – Freshman English (A), Spanish I (B), etc.)
List the classes you expect to take moving forward including an indication of any which may be AP courses or taken at local Colleges/Universities *
List all activities that you are invovled in with the high school (sports, clubs, etc.) and include your positions (captain, member, officer, etc. *
List all extracurricular activites that you are involved with outside your high school (church, clubs, sports, etc.) and include your positions (captain, member, officer, etc.). *
List all volunteer or other activities including employment that you are involved with and include your positions. *
Share with us, in your own words what your goals are for a future career:       *
Share with us, in your own words, what you plan on studying to help you achieve this goal (think college major): *
Share with us where you would like 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 you are interested in attending and how you determined your order of preference:       *
Have you ever had an Individual Education Plan (IEP) or 504 Plan while in High School? *
Do you work with any tutors? If yes, please share with us who you are working with.
How did you hear about Collegiate Concierge and Coaching? *
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