Sample Questionnaire

To get your chances of admission report, we ask that you provide the following information.  Not all information is required, but the more you provide, the more accurate your chances of admission report will be.

Once you have compiled your profile information, you are ready to get your chances of admission or for additional details about our service, see How It Works.

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Background

• Student's Full Name:                                                    
• City:                                                    
• State/Country:            
• Gender:  ☐ Female  ☐ Male
• Ethnicity:  ☐ African-American  ☐ American Indian  ☐ Asian  ☐ Hispanic  ☐ Caucasian  ☐ Other
• Applying as an International Student?  ☐ Yes  ☐ No
• Parent's Education:  ☐ No High School  ☐ Some High School  ☐ High School Graduate  ☐ Some College  ☐ College Graduate  ☐ Advanced Degree
• Other Parent's Education:  ☐ No High School  ☐ Some High School  ☐ High School Graduate  ☐ Some College  ☐ College Graduate  ☐ Advanced Degree
• Household Income:  ☐ $25,000 or under  ☐ $25,001 to $50,000  ☐ $50,001 to $75,000  ☐ $75,001 to $100,000  ☐ $100,001 to $125,000  ☐ $125,000+

Academics & Tests

• High School
  • High School you attend or from which you graduated:                                                    
  • Type of High School:  ☐ Public  ☐ Private  ☐ Parochial  ☐ Home School
  • Estimated percentage of graduating senior class that will attend a 4-year college or university:            
  • Class Size:            
  • Class Rank (choose one)
    • Exact Class Rank:            
    • or Class Rank %:            
    • or Estimated Class Rank %:            
  • What is your grade point average (GPA)?
    • GPA:            
    • out of:  ☐ 4.0  ☐ 5.0  ☐ 6.0
  • Is the GPA provided:  ☐ Weighted  ☐ Unweighted  ☐ Not Sure
• Standardized Testing
  • PSAT Scores
    •    ☐ None  ☐ Yes - new test (Oct 2015 or after)  ☐ Yes - old test (pre Oct 2015)
    • PSAT Scores - October 2015 and after
      • • Total:            
        • Reading and Writing:            
        • Math:            
      • • Reading:            
        • Writing and Language:            
        • Math:            
    • PSAT Scores - pre October 2015
      • Reading:            
      • Math:            
      • Writing:            
  • SAT Scores
    • • Critical Reading:            
      • Math:            
      • Writing:            
    • • Critical Reading:            
      • Math:            
      • Writing:            
  • ACT Scores
    •    ☐ None  ☐ Yes - new test (Sept 2015 or after)  ☐ Yes - old test (pre Sept 2015)
    • ACT Scores - September 2015 and after
      • • Composite Score:            
      • • English:            
        • Mathematics:            
        • Reading:            
        • Science:            
        • Writing:            
      • • ELA:            
        • STEM:            
    • ACT Composite Scores - pre September 2015
      •              
      •              
      •              
  • SAT II Subject Tests
    • • Subject:            
      • Score:            
    • • Subject:            
      • Score:            
    • • Subject:            
      • Score:            
    • • Subject:            
      • Score:            
  • AP Tests
    • Does your high school offer Advanced Placement (AP) courses?  ☐ Yes  ☐ No
    • Projected number of AP classes or college classes completed (at school or nearby college) by graduation:            
    • • Subject:            
      • Score:            
    • • Subject:            
      • Score:            
    • • Subject:            
      • Score:            
    • • Subject:            
      • Score:            
    • • Subject:            
      • Score:            
  • TOEFL
    • Reading:            
    • Listening:            
    • Speaking:            
    • Writing:            
    • Total Score:                                                    
  • IB Tests
    • Are you enrolled in the International Baccalaureate (IB) Program?  ☐ Yes  ☐ No
    • • Subject:            
      • Score:            
    • • Subject:            
      • Score:            
    • • Subject:            
      • Score:            
    • • Subject:            
      • Score:            
    • • Subject:            
      • Score:            
• Honors
  • High School Academic Honors:  ☐ AP Scholar  ☐ Citizenship Award  ☐ Dean's List  ☐ Honor Roll  ☐ Departmental Honors or Award (e.g. Math)  ☐ National Honors Society  ☐ National Merit Scholar  ☐ National Merit Scholar Semi-Finalist  ☐ National Merit Scholar Letter
  • Other Honors:                                                    
  • Has any of your written work been published?  ☐ Yes  ☐ No
• Problems
  • Have you ever been caught cheating?  ☐ Yes  ☐ No
  • Have you ever been suspended?  ☐ Yes  ☐ No
  • Have you ever been expelled?  ☐ Yes  ☐ No
  • Have you ever been convicted of a crime?  ☐ Yes  ☐ No

Activities

• High School Sports
  • What high school athletic recognitions have you received?  ☐ Team Captain  ☐ Team MVP  ☐ All Conference/League  ☐ All Area/Regional  ☐ All State  ☐ All American
• Job
  • Have you had a part-time job during the school year?  ☐ Yes  ☐ No
  • Job hours per week:            
• Community Service
  • Have you participated in community service activities?  ☐ Yes  ☐ No
  • What was your level of participation?  ☐ Volunteer (applies to most students)  ☐ Leader of event/program organizer  ☐ Founder of new event/programming
  • Service hours per month:            
• High School Activities
  •    ☐ Class President  ☐ Club Member  ☐ Newspaper editor  ☐ Newspaper staff  ☐ Yearbook Editor  ☐ Yearbook Staff  ☐ Band Member  ☐ Drama  ☐ Chorus  ☐ Govt. President  ☐ Govt. Officer  ☐ Band 1st Chair  ☐ Lead Debater  ☐ Chess Team  ☐ Math Team  ☐ Debate Team  ☐ Class Officer  ☐ Varsity Sports  ☐ Model UN  ☐ Boy / Girl Scouts
• Other Activities
  • Description:                                                    
  • How many hours per week?            
  • Description:                                                    
  • How many hours per week?            

Applications

• Timing
  • When do you plan to start college?            
  • • Do you plan to apply early action or early decision to any of the colleges you selected?  ☐ Yes  ☐ No
    • Which colleges will you apply early to?                                                    
• Recruitment
  • Are you a recruited athlete at any of the colleges you selected?  ☐ Yes  ☐ No
  • If so, which schools are recruiting you?                                                    
• Alumni/ae Relations
  • Did any of your parents or siblings attend the colleges you selected as an undergraduate?  ☐ Yes  ☐ No
  • Which colleges?
    • •    ☐ Parent  ☐ Brother or Sister
      • attended:                                                    
    • •    ☐ Parent  ☐ Brother or Sister
      • attended:                                                    
    • •    ☐ Parent  ☐ Brother or Sister
      • attended:                                                    
    • •    ☐ Parent  ☐ Brother or Sister
      • attended:                                                    
    • •    ☐ Parent  ☐ Brother or Sister
      • attended:                                                    
• Other Questions
  • Will you be applying for financial aid?  ☐ Yes  ☐ No
  • How did you hear about us?  ☐ Internet Search Engine  ☐ High School Newspaper  ☐ Postcard  ☐ Word of Mouth  ☐ Google Ad  ☐ Facebook

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