COLLEGE GUIDANCE PARTNERSHIP
BACKGROUND & PREFERENCE  SURVEY
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Welcome. If you called up this form, you're ready to commence your college journey, and the College Guidance Partnership is ready to help. This form will assist us in developing your Partner Profile, and provide baseline information for our initial consultations with you. Please complete all lines to the best of your ability.

NOTE TO RESPONDENTS:  Unless you have special form software installed on your computer, data you input cannot be saved. If you are unable to complete this form in one sitting, print out a hard copy for your files and submit the portion you have completed. Simply pick up where you left off on your return to this site, re-supplying only your name and e-mail address at the top of the form. A button to submit your information can be found below the last data entry field. 

Contact information:

Your name:
Email address:

Title	Mr. Miss Mrs.
Street Address
Address (cont.)
City
State/Province
Zip +4
Country
Home Phone
Work Phone	N/A
FAX	N/A
URL	N/A

Identification Group Information:

Date of Birth
Gender	Male Female
Ethnicity	Caucasion African American Latin American Asian American American Indian Other
Citizenship
Marital Status	Single Married Single Head of Household
Primary Language	English Spanish French German Italian Japanese Chinese Korean Other
Secondary Language	English Spanish French German Italian Japanese Chinese Korean Other

Family Information:

High School Data:

Academic Data:

Transcript Information:
Please list course names for each year indicated with final grade if available.

Grade 9
                 Class and Final Grade

Grade 10
                 Class and Final Grade

Grade 11
                 Class and Final Grade

Grade 12
                 Class and Final Grade

Please list all advance placement courses taken to date with final grade if available

Please list all college level courses taken to date with name of school and final grade if available

Placement Test Data:

Academic Awards Information:
Please list all academic awards earned, whether it's school or non-school award and
class year you earned it

            Award                                    School/Non-School                            Class Year

Athletic Information:
Please list all academic awards earned, whether it's school or non-school award and
class year you earned it

Extracurricular Activities Information:

Activity                                                                                                       Description      

Competitions: Please List and Describe

Work Experience Information:

Please list your practical work experience, most recent first 

            Employment Dates         Employer                           Type of Work                Hours/Week

Summer Programs and Experience:

Preliminary College Preference Data:

Other Information:

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