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Dollarway College & Career Intake Form
Mrs. Marla
Complete and submit before September 25, 2020
Enter Date
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Student Name
Your answer
Student Address
Your answer
Student Cell Number
Your answer
Student Email Address
Your answer
Parent Name
Your answer
Parent Telephone Number & Email Address
Your answer
Gender
Male
Female
Clear selection
Graduation Expected Year
Your answer
Student is (Information Necessary for Financial Aid Purposes)
Independent (meaning you live on your own)
Dependent (live with parent or guardian)
In Foster Care
Ward of the Court
Clear selection
Ethnic Origin
Hispanic/Latino
Non-Hispanic
Clear selection
Race
American Indian/Alaskan Native
Asian American
White/Caucasian
African-American
Native Hawaiian
Clear selection
What are your Initial Needs ( Check workshops & activities you believe will be helpful to you) Check all that apply to you.
Academic Planning
Career Exploration & Planning
College Admissions
Goal Setting
Self-Esteem
Time Management
Act Preparation
College Planning
Decision Making Skills
Motivation
Stress Management
Understanding Connection Between Academic and Careers
Attitude (toward school and work)
College Campus Visits
Financial Aid
Real World Budgeting
Study Skills
After finishing High School, what do you plan to do?
4 Year College
2 Year College
Technical/Vocational School
Enter the Armed Forces Fulltime
Enter the Armed Forces and continue my education
Other
Unsure
Clear selection
Would you like an individual meeting with your school College & Career Coach Mrs. Marla? Note: During COVID-19 we can meet through Google meet (Video) or Google hangout (Chatting) .
Yes
No
Clear selection
Do you have any Paid work Experience (Such as McDonald's, Walmart, etc)
Yes
No
Clear selection
Do you have any Volunteer Work Experience (Such as baby sitting, or mowing a yard for free)
Yes
No
Clear selection
What is your Cumulative GPA
Your answer
What is your ACT Score (Skip if you do not know)
Your answer
What is your desired degree or what do you plan to major in after high school; nursing, criminal justice, etc.
Your answer
Where do you plan to attend college or vocational school?
Your answer
Have you applied to any colleges is so where?
Your answer
Ms. Marla - Dollarway College & Career Coach Email:
mbarnes@dollarwayschools.org
Office Location: Dollarway High School
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