College Consulting Intake Questionnaire – Garbini Education and Career Consulting, LLC

Coaching Questionnaire

Please type responses to all questions and click send to deliver to your coach. All information is PRIVATE and strictly CONFIDENTIAL.

First Name

Middle Name

Last Name

First Name

Middle Name

Last Name

Email

Phone

Street Address

City

State

Zip Code

Country

Current academic institution type:

High School Specialized Secondary School College

Current academic institution name

Have any tests or exams been conducted to assess this student’s needs in the past three years?

Yes No

If yes, what tests have been conducted?

Does the student currently have a IEP in place?

Yes No

Does the student currently have a 504 in place?

Yes No

Current GPA (for the term)

Cumulative GPA

SAT/ACT Score

Is this student working with other consultants or coaches at this time for any other services?

Yes No

Is there any additional information you feel will help us serve this student more effectively?