Intake Form

Please only fill this in if you have already been in contact with Sara.

If you would like to set up an initial consultation, please contact Sara.

Initial Meeting Questionnare

Student Contact Information
Student Name
First Last
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell Phone
Home Phone
Date of Birth
Month
Day
Year
Parent/Guardian Contact Information
Parent/Guardian 1 Name:
First Last
Relationship to student:
Email
Cell Phone
Home Phone
Please indicate if address is the same as student's.
- Yes
- No
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent/Guardian 2 Name:
First Last
Relationship to student:
Email
Cell Phone
Home Phone
Please indicate if address is the same as student's.
- Yes
- No
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent/Guardian 3 Name:
First Last
Relationship to student:
Email
Cell Phone
Home Phone
Please indicate if address is the same as student's.
- Yes
- No
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent/Guardian 4 Name:
First Last
Relationship to student:
Email
Cell Phone
Home Phone
Please indicate if address is the same as student's.
- Yes
- No
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Academic Information
High School
Class of
Weighted class rank
Unweighted class rank
Weighted GPA
Unweighted GPA
GPA Scale
Courses (please fill in everything that applies, including planned courses, and indicate AP, IB, Honors, etc.)
Freshman Year
First Semester/Trimester
Second Semester/Trimester
Third Trimester
Sophomore Year
First Semester/Trimester
Second Semester/Trimester
Third Trimester
Junior Year
First Semester/Trimester
Second Semester/Trimester
Third Trimester
Senior Year
First Semester/Trimester
Second Semester/Trimester
Third Trimester
Favorite subject(s)
Least favorite subject(s)
Strongest subject(s)
Weakest subject(s)
Testing Information (Please fill in everything that applies.)
SAT Total Score
Critical Reading
Math
Writing
Date
MM slash DD slash YYYY
PSAT Total Score
Critical Reading
Math
Writing
Date
MM slash DD slash YYYY
ACT Composite
English
Math
Reading
Science
Writing
Date
MM slash DD slash YYYY
PLAN Composite
English
Math
Reading
Science
Date
MM slash DD slash YYYY
EXPLORE Composite
English
Math
Reading
Science
Date
MM slash DD slash YYYY
AP/IB Exam
Score
AP/IB Exam
Score
AP/IB Exam
Score
SAT Subject Test
Score
SAT Subject Test
Score
SAT Subject Test
Score
Extracurricular Activities
What are your main extracurricular activities (sports, clubs, community service, arts, work, hobbies, etc.)?
How have you spent your summers? What do you plan to do during future summers?
College Search Information
Are there any specific criteria that you are looking for in a college (i.e., size, location, religious affiliation, etc.)?
Do you have any ideas about what you want to major in? If so, please list the majors you’re thinking about.
Are there specific colleges that you’re considering? If so, what are they and why are you interested in them?

89378

Initial Meeting Questionnare

Student Contact Information

Parent/Guardian Contact Information

Academic Information

Courses (please fill in everything that applies, including planned courses, and indicate AP, IB, Honors, etc.)

Freshman Year

Sophomore Year

Junior Year

Senior Year

Testing Information (Please fill in everything that applies.)

Extracurricular Activities

College Search Information

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