NiswongerCARE Intake Form
Terms and Conditions
Thank you for taking the time to complete this intake form. Completing this will give us some valuable information as we assist you in planning for life after high school. By agreeing to the terms and conditions, you are granting NiswongerCARE permission to use your mobile/cell number to text helpful reminders and information specific to your postsecondary plan through Signal Vine. Your CARE advisor will also respond to messages from you should you have questions or need assistance. *
Required
During Path to College Events or other gatherings at your high school, you Advisor may take photos. In clicking the agree button below, you are granting permission to NiswongerCARE to use your photo or likeness on social media and the CARE website.
Basic Information
First Name *
Last Name *
Which High School do you attend? *
What grade are you in? *
Birth Date (This is just so we can send a Happy Birthday message to you!)
MM
/
DD
/
YYYY
Personal Email Address (Put N/A if you don't have one) *
Personal Cell Number
Please include the phone number in a 10 digit format with no parenthesis or dashes. Example: 4235551234
Did either of your parents graduate from college? *
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