CAC Student Intake Form

College Admission Coach, LLC Student Intake Form
STUDENT INFORMATION
Full Legal Name

First NameMiddle NameLast Name
Nickname
Date of Birth

MonthDayYear
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Telephone

Area CodePhone Number
Cell Phone

Area CodePhone Number
Email Address
School Attending
Current GPA
Weighted or Unweighted
School Location (City, State)
Current Grade
Are you seriously considering a gap year before starting college?
Race/Ethnicity (Check All That Apply)
If Asian, what type?
What is your gender identity?
What are your preferred pronouns?
Do you identify as LGBTQ+?
FAMILY INFORMATION
Parent 1 Full Name

First NameLast Name
Parent 2 Full Name

First NameLast Name
Sibling 1 Name

First NameLast Name
Sibling 1 Age
Sibling 1 School/College Attending (or Attended)
Sibling 2 Name

First NameLast Name
Sibling 2 Age
Sibling 2 School/College Attending (r Attended)
Sibling 3 Name

First NameLast Name
Sibling 3 Age
Sibling 3 School/College Attending (or Attended)
Sibling 4 Name

First NameLast Name
Sibling 4 Age
Sibling 4 School/College Attending (or Attended)
STUDENT PREFERENCES

What type of college do you see yourself attending? Please review the following and consideryour current priorities before ranking your choices. You may wish to discuss your answers withyour parents.

Geographic Location. Please Rank Choices in order of Importance (1 is most important)

Setting. Rank in order of Importance (1 is most important)

Size of University. Rank in order of importance. (1 is most important)

Type of Institution. Rank in order of importance. (1 is most important)

Atmosphere (Select All That Apply)
What other characteristics are you looking for in your college (i.e. friendly, competitive, great football team to cheer for)?
What school characteristics would you like to avoid?
How important a consideration is institutional prestige?
How intensive an academic workload do you want?
Possible majors being considered:
Other academic interests:
Are there any colleges in which you are currently particularly interested? List them and explain why?
Have you ruled out any colleges? List them and explain why?
Will you need financial aid?
Do you want a part-time job?
Please list the courses you are currently taking and your approximate grades.
Please Attach a copy of your current transcript or submit it separately to Jodi.

Upload a File

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SAT/PSAT Tests Taken to Date and Score

SAT Subject Tests (list subject, date test was taken, and score):

ACT/PLAN Tests taken to date and scores:

AP (list subject, date test was taken, and score):

How do you assess yourself as a student? What do you consider your academic strengths and weaknesses? Do you think your transcript and teacher/counselor reports accurately reflect your academic abilities?
EXTRA-CURRICULAR ACTIVITIES

Please list your most important extra-curricular pursuits. Specify years of involvement and positions of leadership or responsibility, and rank them in importance to you.

School Activities and Sports

Rows	Activity/Sport	Freshman	Sophomore	Junior	Senior	Leadership Position/Responsibilities
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Outside Activities and Sports

Rows	Activity/Sport	Freshman	Sophomore	Junior	Senior	Leadership Position/Responsibilities
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Work/Volunteer/Summer Activities

Rows	Activity/Sport	Freshman	Sophomore	Junior	Senior	Leadership Position/Responsibilities
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Other Hobbies and Interests

Rows	Activity/Sport	Freshman	Sophomore	Junior	Senior	Leadership Position/Responsibilities
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College Admission Coach, LLC Student Intake Form