Sandra Steele, Educational Consultant

New Client Information

Congratulations on taking the next step in your educational and life pursuits.

Students, please complete and submit the following information prior to your first visit with Mrs. Steele.
Parents, please complete our parent evaluation form and submit it to Mrs. Steele.

Email Address:
First Name:
Last Name:
Date of Birth:
Social Security:
Address:
City:
State:
Zip:
Home Phone:
Cell Phone:
Student Email:
Parent Email:
PSAT Score:
PSAT Date:
SAT Score:
SAT Date:
ACT Score:
ACT Date:
Other testing done:
Other testing score:
High School:
Current Grade in School:
Hobbies:
Extracurricular Activities:
Weaknesses:
Strengths:
Intended Field of Study:
State Preferences:	In-State Out-of-State Either Unsure
Small School Interest:
Medium School Interest:
Large School Interest:
Greek Life:
Courses for First Semester:
Courses for Second Semester:
I wish I could travel to:
I wish I could have some outdoor adventure in (i.e. biking, hiking, rafting, skiing, camping, etc.):
I wish I could become better at (i.e. art, drama, writing, tennis, basketball, music, swimming, etc.):
I wish I could learn a new skill in (i.e. sewing, cooking, carpentry, design, etc.):
I wish I could be useful by (i.e. hospital work, tutoring, community service, helping an underdeveloped country, etc.):
I wish I could see what it’s like to be a (i.e. doctor, lawyer, engineer, artist, teacher, sports announcer, business manager, stockbroker, fashion designer, vet, chef, computer specialist, journalist, builder, architect, etc.):