EmailMeForm
SQQ - Student Qualification Questionnaire
Information used for interview ONLY * and is confidential. If you prefer to print a hard copy to scan or fax,
CLICK HERE
Student Name
*
First
Last
Student Date of Birth
*
MM
/
DD
/
YYYY
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Student Phone
*
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-
###
-
####
School Counselor
*
Student Email (not school)
*
Not an email assigned by your school
High School Graduation year
*
i.e. 2024
School Attending Now
*
GPA - 4.0 Scale Only
*
Not Weighted for Advanced Placement or honors. Maximum GPA is 4.0
Middle School Grade Now
i.e. grade 6,7,8
High School Grade Now
i.e. grade 9,10,11,12
College Undergraduate Year
i.e. Year 1,2,3, etc.
College Post Graduate
Describe your current status
Colleges of Interest
*
Interest Field or career goals
*
Awards and Achievements
*
Jobs - Employment
*
ACT Test Score
*
If none enter "0"
SAT Test Score
*
If none enter "0"
Community Service type/hours
*
Father's Email
*
Mother's Full Name
*
Mother's Email
*
Sports interest? What Sports?
Fathers Phone
*
###
-
###
-
####
Mothers Phone Number
*
###
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###
-
####
Father's Full Name
*
Father's Occupation
*
Father's Employer
*
Mother's Occupation
*
Dependent Children Names/Ages
i.e. Mary/14
Mother's Employer
*
Available Funds for College
*
Community Volunteer
*
Community Volunteer Email
*
Email of the community volunteer who contacted you
Comments
*
Submitted on a Secure Server