Success Boston - 2017 Student Interest Form
Transitioning to college can be an exciting and overwhelming process for many students. Success Boston works to ensure that Boston students have the support they need to get ready, get in, and succeed in college.

Through Success Boston, high school seniors or recent graduates can get connected to a transition coach, someone to provide mentoring and help with navigating campus, connecting with peers, accessing on-campus services and resources, and solving problems -- easing the transition to college. Visit to learn more.

If you’re interested in learning more about Success Boston and getting connected to a coach, please complete the following interest form. Your information and privacy will be protected. A Success Boston Coach will follow up with you to share more about coaching, confirm your interest, and to connect you with helpful resources on your journey to a post-secondary degree!

First Name *
Your answer
Last Name *
Your answer
Date of Birth *
Address *
Street, Apt.
Your answer
City *
Your answer
Zip Code *
Your answer
Email Address *
Please be sure to check this for contact from a Success Boston coach.
Your answer
Mobile Phone Number *
Please be sure to check this for contact from a Success Boston coach.
Your answer
Preferred Contact Method *
What is the best way for a coach to reach you?
Place of Birth - Country *
What country were you born in?
Your answer
Gender *
Ethnicity *
Please select the ethnicity you identify with.
BPS Student ID
Please enter your BPS ID. If you do not have one, please leave it blank.
Your answer
What is the name of your high school? *
Either where you are currently a student, or where you graduated from. If your high school is not listed, please select "Other High School" at the bottom of the list.
What is your graduating class year? *
Where are you in the college/postsecondary process? *
Please select any colleges that you are considering attending next year. *
If you are already enrolled or have made a decision after being accepted, please only select ONE option.
Has (at least) one of your parents earned a bachelor's (4-year college) degree? *
Have you completed your FAFSA? *
The FAFSA is the Free Application for Federal Student Aid ( If you have not, your coach will help you complete this important process.
If you would like to work with one of the following Success Boston coaching organizations, please select it from the list below. To learn more about each of these organizations, please reference the "Recruitment Flyer" on the home page of *
Those who select "No Preference" will be matched with a coach based on high school, neighborhood and/or prospective college(s).
Where/when did you fill out this form? *
Additional Information
Is there anything else your Success Boston coach should know? Please include any helpful details about support you may need with completing high school and/or transitioning to college.
Your answer
FERPA Release *
By submitting this form I consent to the use of information provided in this form and my student records for research purposes, to inform strategies to strengthen the Success Boston program and improve student outcomes. I understand that my information may be made available to Success Boston partners including but not limited to the Boston Foundation and affiliated researchers. I also understand that by providing my cell phone number, I agree to receive text messages as a part of my participation in Success Boston. Protecting your privacy is very important. Only authorized persons will have access to your information, except as required by law. Your personal records will be kept strictly confidential by all parties to whom access is granted. Your name will never be used publicly, nor will any description that could identify you. Sharing your information is voluntary. You can still take part in Success Boston even if you do not consent to the use of your information for program improvement and research purposes. For questions or concerns or if you do not want your information to be used for research or evaluation purposes please contact OR call 617-338-4471.
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