Student Survey – College Counseling - Moxie College Counseling

Student Details

Your Name *

First

Last

High School *

High School Graduation Year *

Date of Birth *

Moxie Counselor *

Parent Details

Parent/Guardian 1 *

First

Last

Relationship to Student *

Add Parent/Guardian 2? *

Parent/Guardian 2 *

First

Last

Relationship to Student *

Contact Information

Address

Address Line 1

Address Line 2

City

State

Zip Code

Your phone number *

Phone type *

Secondary phone number

Phone type

Email *

Pick three words that describe you and write them here: *

Choose at least one from the list above and explain what it means to you.

Please list any activities, organizations, clubs, hobbies, or interests that have any significance to you. *

Choose at least one from the list above and explain what it means to you.

What are your best academic subjects? *

Literature
Math
History
World Languages
Performing Arts
Visual Arts
Writing
Sciences
Government/Civics
Music
Other

Please explain your choices. Also, is your best subject also your favorite subject? Why or why not? *

Describe a teacher past or present who was remarkable to you (either good or bad).

Do you read for pleasure?

Yes
No
I used to.
No, but I want to.

What sort of books have you/would you/do you read?

Is there anything about your report cards that you would like a college to understand better (e.g., particular grades, high school change, challenging teacher)? *

Please explain. *

Most students don’t know what they want to study in college or pursue afterward, but if you have some ideas for yourself, let us know here: *

What makes you proud? *

If you could snap your fingers and change something in your life, would you?

Tell us more. *

To you, which of the following are important factors that you will consider during your college admissions process? *

Prestige
Cost
Location
School Size
Particular academic offerings
Performing arts/fine arts
Rank (USNWR, Princeton Review, Forbes, etc.)
Proximity to home
Climate
Geographic region
School spirit
Athletic programs/recruitment
Experiential learning (internships, co-ops, research, etc.)

What, if any, are concerns you have about the college admissions process?

Standardized testing
Admissibility (“getting in”)
Role of parent
Application essays
Planning college visits
Extra-curriculars
Athletic recruitment
Anxiety/stress
Time management of the process
Finding the best fit
High school course selection
Letters of recommendation
Summer planning
Arts portfolio/auditioning

For both questions above, feel free to explain your choices here:

Do you have a dream college?

What is it, and why might it be a good fit for you? *

Is there anything else you want to share before the first session? *

Let us know what that is here: *