Betterton College Planning

Student Questionnaire

Student's name: ______High school graduation year: ______

Father's name: ______

Mother's name: ______

Student's home address: ______

Gender ______Ethnicity (optional): ______

Home telephone: ______Home Fax: ______

Student cell ______Student e-mail: ______

Name of school currently attending: ______

Location: ______

Any prior schools? (9th grade on) ______

Names and ages of brothers and sisters and school/college attending:

______

Father's college and class: ______

Father's graduate school and class: ______

Mother's college and class: ______

Mother's graduate school and class: ______

Are your parents or any other relatives significantly involved in any college of possible interest to you? If so, please name the person, college, and connection:

______

College Preferences (Number choices from 1 (most desirable) to 5 (least desirable):

Geographic location?

Northeast ____ Mid-Atlantic ____ Mid-West ____

South ____ Far-West ____ Doesn't matter ____

Setting?

Urban ______Suburban ______Rural _____ Doesn't matter_____

Size?

Very small (under 1,000 undergraduates) ______Small (1,000 - 3,500) ______Medium (3,500 - 6,000) ______Large (6,000 - 15,000) ______Very large (15,000 - 35,000) ______

Doesn’t matter ______

Type of Institution?

College (undergraduates only) ______University (undergraduates and graduates) ______Professional (career-specific) ______Doesn't matter ______

Atmosphere?

Traditional ______Middle-of-the-road ______Liberal ______

Progressive/Alternative _____ Doesn’t matter ______

Prestige/Ranking?

Very important ___ Somewhat important____ Not that big a deal ____

What other characteristics appeal to you?

______

Hierarchy of preferences:

Are any of the above characteristics essential? If so, which ones? ______

Not essential, but very important: ______

Have a strong preference: ______

What characteristics would you like to avoid?

______

Intended major: ______

Possible majors if undecided:

______

Do you plan to apply to a arts and sciences program (liberal arts) or to a pre-professional program like engineering, business, nursing, special pre-med, etc ______

Do you have a career goal in mind? _____ If yes, what is it? ______

Academic interests apart from your major: ______

How intensive an academic workload do you want? ______

List your courses (current or recently completed) and estimated or final grades. Indicate Honors, AP, or IB.

______

GPA Unweighted ______GPA Weighted _____ Class Rank: _____ of _____

Tests taken to date and scores:

PSAT RW ______M ______

Old SAT Date ______CR ______M ______W ______

Old SAT Date ______CR______M ______W ______

New SAT Date ______RW ______M______Optional Essay ______

ACT Date ______Comp ___ Eng ___ M ___ R ___ Sci ___ Optional Writing ___

SAT Subject Tests:

Date Exam Score

______

Advanced Placement:

Date Exam Score

______

Extra-Curricular Activities In-School (indicate leadership positions):

______

School Sports (indicate leadership positions):

______

Outside Activities:

______

Summer Activities: (Show year)

______

Any work for pay? ______

Hobbies and Interests:

______

Community Service – show any volunteer work with organization, your role, number of hours, and year in which you did the service

Which of the above – school activities, sports, outside activities, work, summer, hobbies, etc, do you plan to continue in college?

______

If one of the above is in the arts area – music, dance, theater, visual arts – do you plan to submit an example of your work to the college? ______

If one of the above is in the athletic area, do you plan to contact the coach and show evidence of your ability? ______

Awards, Honors, Recognition (academic and others):

______

Are there any colleges in which you are particularly interested at this time? If you have visited any of the colleges, indicate with a “(v)” after the name.

______

Have you ruled out any colleges? Please name them and explain why:

______

How would 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? ____

If no, explain what factors in school have affected your performance.

______

Is there anything going on outside of school or at home that has affected your performance or ability to participate in activities?

______

Tell me anything about yourself that would help me understand you better - physical limitations, learning difficulties, values, interests, goals, etc.

______

I need to have your completed questionnaires and a copy of your most recent transcript at least two days prior to our meeting. Feel free to include any other material that would be helpful for me to see before our session. Either send the forms electronically or fax them to 609 737 7378.