Student Contact Info

First Name:
Last Name:

Phone:
Email:

Parent Contact Info

Please fill in the contact info for whichever parent or guardian you would like us to contact.

First Name:
Last Name:
Email:

Phone:
City:
State:

School Info

School:

Other School (if not in list):

Started School:

Expected Graduation:

GPA:

SAT/ACT:

Major:

How are you paying for college?

Personally
Family/Friends
Loans

Parent/Guardian
Financial Aid
Other

I am:

Married
22+
Military Child
Graduate Student

In the Military
Student Athlete
In High School
Under 18

How did you hear about us?

A Specialist	Internet Search Engine
Other	Word of Mouth / From a Friend

If you selected other, please specify:

If you selected Word of Mouth/From a Friend, who referred you?

Availability

We normally interview potential clients between 10 am and 2 pm on Mondays and Fridays and between 2 and 6 pm on Wednesdays. If you are available to meet with us for half an hour on one of these days in the next two weeks, please specify.

Weekday:
Time Slots:	2:00-2:30 2:30-3:00	3:00-3:30 3:30-4:00	4:00-4:30 4:30-5:00	5:00-5:30 5:30-6:00
Time Slots:	10:00-10:30 10:30-11:00	11:00-11:30 11:30-12:00	12:00-12:30 12:30-1:00	1:00-1:30 1:30-2:00

Otherwise, please provide three dates and times during which you are available for a 30-minute in-person interview on campus in the next two weeks.

Date:		Time:
Date:		Time:
Date:		Time: