Inez K. Jones Consulting - Student Intake Form

STUDENT INFORMATION

Name:
Home Phone:
Cell Phone:
Email:
Current Address:
City:
State:
Zip Code:
Grade Level:
GPA Weighted:
GPA Unweighted:
High School:
City:
State:
Zip Code:
How many in household:
How many siblings:
How many in college:
Best Time To Contact:
Birth Date:

PARENT INFORMATION

Name:
Relationship:
Cell:
Email:
Current Address:
City:
State:
Zip Code:
Is/Was parent or grandparent a veteran:
 Yes 
 No 

MORE STUDENT INFORMATION

Major:
Class Rank:
ACT Score:
Girl/Boy Scout:
 Yes 
 No 
Expected Family Contribution:
Pell Grant:
Map Grant:

HONORS / AWARDS

1.
2.
3.
4.

 

COMMUNITY SERVICE

HOURS

1.
2.
3.
4.
  Total Hours:

PASSIONS / LIKES

1.
2.
3.
4.
5.

OBSTACLES / STRUGGLES

1.
2.
3.
4.
5.

HIGH SCHOOL, COLLEGE, & LIFE GOALS

1.
2.
3.
4.
5.

EMPLOYMENT HISTORY

DATES

1.
2.
3.
4.

EXTRA-CURRICULAR ACTIVITIES

National Honor Society:
 Yes 
 No 
Sports:
Teams:
Clubs:
Band:
 Yes 
 No 
Choir:
 Yes 
 No 
Other

LEADERSHIP ROLES

ACADEMIC STRENGTHS

TOP 5 COLLEGES

STATUS

College #1:
College #2:
College #3:
College #4:
College #5:

CURRENT CLASSES

GRADE

Class #1:
Class #2:
Class #3:
Class #4:
Class #5:
Class #6:
Class #7:
Class #8:

LETTERS OF RECOMMENDATION

1.
2.
3.
4.

FOR OFFICE USE ONLY

Notes:
Recommendations:
         

Print this form before hitting Submit and bring it with you to your appointment.
There is no guarantee that students will win scholarships or be accepted into colleges.