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Student Intake Form - The Full Ride Program
Welcome to The Full Ride Program,
Please complete this REQUIRED student intake form. We will use all data collected to build your profile and manage your individual academic needs.
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* Indicates required question
Email
*
Your email
Name
*
Your answer
Phone Number
Your answer
What grade are you currently in?
*
Your answer
Select which days of the week work best for your sessions.
*
Option 1
Monday
Tuesday
Wednesday
Thursday
Sunday
Required
What time would you like your sessions to begin
*
5pm
6pm
7pm
8pm
I am flexible.
Required
What school do you attend?
*
Your answer
What clubs or sports do you participate in?
*
Your answer
How many volunteer hours have you earned thus far?
*
None
1-25 Hours
25-50 Hours
50-100 Hours
100+ Hours
What challenges are you facing in school currently? (Check All That Apply)
*
Study Habits
Note Taking Skills
Actively Listening
Starting Hard Assignments
Understanding What I Need To Do
Staying Organized
Procrastination
Required
How often do you study each day?
*
Never (0 hours)
Rarely (1-2 hours)
Often (2-4 hours)
How often do you take notes in class?
*
Never
Occasionally
Sometimes
Often
Always
How often do you review the notes that you have taken?
*
Never
Occasionally
Sometimes
Often
Always
On a scale of 1- 10 what is your level of understanding about Executive Functioning?
*
1 = Little Knowledge 5 = Very Knowledgeable
1
2
3
4
5
6
7
8
9
10
How do you prefer to learn?
*
I'm an independent learner (I only want help when I ask for it)
One on One (I need a tutors assistance at all times)
Small Group Setting (I like working with 1-2 other students)
What is your learning style?
*
Visual (spatial):You prefer using pictures, images, and spatial understanding.
Aural (auditory-musical): You prefer using sound and music.
Verbal (linguistic): You prefer using words, both in speech and writing
Physical (kinesthetic): You prefer using your body, hands and sense of touch
Required
Have you taken the SAT or ACT?
*
Yes, SAT
Yes, ACT
Yes, Both
No
I will not be taking these exams
I plan to use the Covid-19 Waiver
Required
What were your scores?
*
Your answer
Use this space to share colleges, universities or programs that you are interested in visiting, attending or learning more about this year.
*
Your answer
How many college visits have you been on?
None
1-2
2-4
5+
In 50 words or less describe your desired goals or outcome by participating in this program.
*
Your answer
A copy of your responses will be emailed to the address you provided.
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