New Student Intake Form | Essential College

New Student Intake

First Name

Last Name

Mobile Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Birthday

Current High School

Graduation Date

Guidance Counselor

Previous High School

Dates Attended

Language spoken at home

Does Student have an IEP/504 plan?

Family Information

Mother's Name

Address (if different than student)

Mobile Phone Number

Occupation

Employer

College Attended

Degree

Graduate/Professional School

Degree

Father's Name

Address (if different than student)

Mobile Phone Number

Occupation

Employer

College Attended

Graduate/Professonial School

Degree

Siblings - Names and Ages

Academics

Current Year Curriculum

Unweighted GPA

Weighted GPA

Class Rank

*Please send us a copy of your unofficial transcript via email to essentialcollegecoaches@gmail.com

Academic Honors/Awards

Testing

PSAT Scores

SAT Scores

ACT Scores

Extracurricular Activities:

Disciplinary History

Absentee/Tardy