Higher Education Readiness Survey
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1
. Student Information
Student Information
Name
Email
Address
Apt
City
Zip
Personal Phone
Worksite
Work Phone
2
. I prefer to be contacted by:
I prefer to be contacted by:
US Mail
Personal Phone
Work Phone
Email
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3
. My Highest Level of Education is:
My Highest Level of Education is:
Some College - ECE Courses Only
Some College - ECE & GE Courses
Some College - ECE Certificate
Some College - GE or IGETC Certified
Associates Degree - ECE
Associates Degree - non-ECE
Bachelors Degree - ECE
Bachelors Degree - non-ECE
Other (please specify)
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4
. My current Education Goal
My current Education Goal
Focus on ECE Certificate
Focus on GE Certification
Confer an Associate's Degree
Confer an Associate's Degree then transfer
Transfer without an Associate's Degree
Other (please specify)
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5
. Program(s) of Interest
Program(s) of Interest
Bachelor's Degree
Teaching Credential (Single-Subject)
Teaching Credential (Mulitple-Subject)
Teaching Credential (Early Learning)
Master's Degree
Other (please specify)
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6
. Field of Interest
Field of Interest
Child Development
Liberal Arts with an emphasis in Child Development
Business Administration
Other (please specify)
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7
. I am interested in the following Colleges/Universities (check all taht apply):
I am interested in the following Colleges/Universities (check all taht apply):
Antioch University
Brandman University
University of La Verne
CSU Channel Islands
CSU Cal Poly
UCSB
Undecided
Other (please specify)
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8
. My preferred course schedule is (check all that apply):
My preferred course schedule is (check all that apply):
Monday - Thursday Evenings Only
Saturday
Friday
Online
Combination
Other (please specify)
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9
. My Interest in pursuing a higher education is dependent on the following:
My Interest in pursuing a higher education is dependent on the following:
Tuition Cost
Financial Support Available - Loans
Financial Support Available - Discounts, Scholarships, Grants, etc
Release Time from Work
English Requirements
Math Requirements
Location
How soon I can start
How soon I can finish
Curriculum Requirements (Core, Electives, General Education)
Online Courses Available
Grading Options (Pass/No Pass)
Cohort Option (same group of students throughout the program)
Cohort Option (course schedule pre-planned)
Ability to choose how many courses to complete per term
Other (please specify)
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10
. I'd rate my overall readiness to move forward:
I'd rate my overall readiness to move forward:
Ready
Not Ready
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11
. My next steps to transfer are:
My next steps to transfer are:
Attend an Information Session - Admissions
Attend an Information Session - Financing Your Education
Meet with an Admissions Counselor to review my transcripts
Apply to the University of my Choice
Complete the FAFSA
Apply for Scholarships
Complete a course or set of courses toward transfer
Other (please specify)
12
. Comments or Questions
Comments or Questions
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