Consultation Request

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Who is signing up for this consultation?

I am the student.

I am the parent/guardian.

Other:

Clear selection

Your first name

Your last name

Phone number

Do you prefer a phone call or text message?

A call

A text

No Preference

Clear selection

Email Address

Student name

(if not listed above)

How soon are you wanting to meet?

Within the month

Within 3 months

Within 6 months

I am not sure. I am still exploring

As soon as possible

I am not looking for college counseling, but I am interested in Binnacle's other programs

Clear selection

Please select the best day and time of day for your consultation:

(A verification email will be sent when your appointment has been confirmed)

8:00 AM - Noon

1:00 PM - 4:00 PM

5:00 PM - 7:00 PM

Anytime of the day

Virtual Preferred

In-person Preferred

Monday

Tuesday

Wednesday

Thursday

Friday

What services are you interested in?

Please select as many as applicable

ACT Tutoring

Where to start with this college admissions stuff

A custom plan with application dates and fees for specific schools

What is a custom visit and how do I schedule one

Financial Aid help (includes federal, state, private, institutional, grants, and loans)

Marketing and recruitment: Non-athlete

Marketing and recruitment: Athlete

Competitive essay help

Resume + cover letter help

Interview prep

Speaking Engagement

Other:

High School Graduation Year

2025

2026

2027

2028

2029 or later

Clear selection

Which best describes the student's most recent unweighted GPA?

A (3.9 - 4.0)

A- (3.7 - 3.8)

B+ (3.3 - 3.6)

B (3.2 - 3.0)

B- (2.7 - 2.9)

Below a B- (less than 2.7 or less than 80)

Prefer not to answer/ I am not sure

Clear selection

Which best describes the student's highest composite ACT score? (NOT "Superscore")

32 - 36

30 - 31

27 - 29

24 - 26

20 - 25

15 - 19

Below 15

Prefer not to answer/ I am not sure

Have not taken the ACT

Clear selection

Which best describes the student's ACT "Superscore?"

32 - 36

30 - 31

27 - 29

24 - 26

20 - 25

15 - 19

Below 15

Prefer not to answer/ I am not sure

Have not taken the ACT

Clear selection

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms