College Counseling Intake Form Student's Full Name * First Name Last Name Preferred Name Student's Preferred Pronouns * He/him/his She/her/hers They/them/theirs Other Date of Birth MM DD YYYY Student's Email * Student's Cell Phone Current School * Year of HS Graduation * 2025 2026 2027 2028 2029 2030 Transfer Student Previously Graduated Schools Previously Attended Please include name of school(s) and grades attended. Is the student an American Citizen? Yes No Has the student ever completed educational or psychological testing? Yes No If applicable, please share more about your child's learning differences and/or any current or past diagnoses. Parent/Guardian 1 Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * Email * Parent/Guardian 2 Name First Name Last Name Address Same as Parent 1 Above Parent 2 Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * Email Parents' Marital Status (check all that apply) Single Married Divorced Partnership Mother Deceased Mother Remarried How did you hear about The School Counseling Group? Friends/Family School/Program Repeat Client/Family Professional Internet Other Is there any other information that you want to share that you didn't discuss on your initial call? Thanks for completing the intake form. Please be sure to return to your email to complete the remaining paperwork.
