GO Center 2018-2019 Intake Form
Welcome to the GO Center! For our mentors to better serve you, we would like to know more about you. Please fill out the intake form to the best of your ability.
DATE (MM/DD/YYYY) *
MM
/
DD
/
YYYY
GO Center Mentor who assisted you:
Your answer
High School *
First Name *
Your answer
Middle Initial
Your answer
Last Name *
Your answer
Birthday (MM/DD/YYYY) *
Your answer
Current Grade *
Expected Graduation Date *
Required
Gender *
Ethnicity *
Required
Primary Language Spoken at Home *
Highest Grade Level Father Completed
Highest Grade Level Mother Completed
Are you on Free or Reduced Lunch? *
What is your graduation plan?
SAT Test Score
Please enter the numerical composite grade (i.e. 1800). If you have not taken the SAT, please fill in response with "Have Not Taken".
Your answer
ACT Test Score
Please enter the numerical composite grade (i.e. 24).If you have not taken the ACT, please fill in response with "Have Not Taken".
Your answer
PSAT Test Score
Please enter the numerical composite grade (i.e. 1100). If you have not taken the PSAT, please fill in response with "Have Not Taken".
Your answer
TSI Test Scores (Math, Reading, and Writing)
Please enter the numerical grades for each section (Math, Reading and Writing). If you have not taken the TSI, please fill in response with "Have Not Taken".
Your answer
I plan to go to college when I finish High School.
My parent/guardians are encouraging me to go to college.
My friends plan on going to college.
I enjoy school.
My teacher(s)/counselor(s) care if I go to college.
What College(s) and University(s) are you applying for?
Your answer
What is your anticipated major(s)?
Your answer
Have you completed a FAFSA? *
Reason for Visiting GO Center *
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