Student Questionnaire

Note To Students:

The following questionnaire asks for a variety of information regarding your college plans. Please fill out the questionnaire as honestly and carefully as possible. Your answers will be of great help to me in advising you about college. Your responses will also help me as I write your letter of recommendation. This questionnaire will remain completely confidential.

Thank you,

Guidance Counselor

Background Information

Full Name______________________________________________ Nickname_________

Home Address________________________________ Phone____________________
___________________________________________
___________________________________________

Date of Birth ________________________________ Place ____________________

U.S. Citizen? ________________

Name of father/stepfather/guardian (circle one) _________________________________
High school and/or college attended __________________________________________
Occupation______________________________________________________________
Employer _______________________________________________________________

Name of mother/stepmother/guardian (circle one) _______________________________
High school and/or college attended___________________________________________
Occupation______________________________________________________________
Employer________________________________________________________________

Do you have any brothers? ______Ages? _______________Are they in college? ______
If so, where? _________________________

Do you have any sisters? ________Ages? _______________Are they in college? ______
If so, where? _________________________

Student Data

1. What school clubs and activities have you been involved with? Tell how you have been involved.











2. What honors and prizes have you received? Explain.











3. What community activities have you been involved with? Explain.











4. What sports have you been involved with? Explain.











5. Have you participated in activities at your house of worship, mosque, synagogue, church, or other religious organization? Explain.











6. What special talent or passion do you consider most important about yourself? Include hobbies, interests, or political issues.











7. Are there any special circumstances at home that should be mentioned to the colleges (e.g., divorce, separation, unusual tensions, illness, special relationships, etc.)?
   
   
   
   
   
   
   
   
   
   
   
8. What are your “hot” issues? What do you get excited about other than your own life?

College Plans

1. What possibilities have you considered regarding a career?











2. Are you interested in particular colleges at this point? If so, list them.











3. When you think of yourself, what are the first words that come to mind?











4. What would you like a college admissions officer to know about you as a person?

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