Student Success Coach Request Form
Exit this survey >>
1. Coaching Form
Thank you for your interest in Student Success Coaching! Please fill out the following information and your new coach will contact you soon:
*
1
. Please fill out the following questions about yourself:
Please fill out the following questions about yourself:
Name:
Student ID or Birth date:
Email Address:
Phone Number:
What is the best way to reach you (phone or email)?
When is the best time to reach you?
*
2
. Please check all the hours you are available to meet with a coach:
Monday
Tuesday
Wednesday
Thursday
Friday
9:00
Please check all the hours you are available to meet with a coach: 9:00 Monday
Tuesday
Wednesday
Thursday
Friday
10:00
10:00 Monday
Tuesday
Wednesday
Thursday
Friday
11:00
11:00 Monday
Tuesday
Wednesday
Thursday
Friday
12:00
12:00 Monday
Tuesday
Wednesday
Thursday
Friday
2:00
2:00 Monday
Tuesday
Wednesday
Thursday
Friday
3:00
3:00 Monday
Tuesday
Wednesday
Thursday
Friday
4:00
4:00 Monday
Tuesday
Wednesday
Thursday
Friday
5:00
5:00 Monday
Tuesday
Wednesday
Thursday
Friday
6:00
6:00 Monday
Tuesday
Wednesday
Thursday
Friday
*
3
. When and where did you complete your last school experience?
When and where did you complete your last school experience?
*
4
. Do you know what you want to major in at Edison College? If yes, please specify which major.
Do you know what you want to major in at Edison College? If yes, please specify which major.
*
5
. Are you working in a job while attending classes at Edison? If yes, how many hours do you work?
Are you working in a job while attending classes at Edison? If yes, how many hours do you work?
*
6
. What are your three main concerns that could prevent you from succeeding in school?
What are your three main concerns that could prevent you from succeeding in school?
1.
2.
3.
*
7
. In what areas can we help you succeed with your college goals?
In what areas can we help you succeed with your college goals?
Time Management
Test Taking
Test Anxiety
Selecting a Major
Note Taking
Procrastination
Fear of Math
Memory Skills
Computer Skills
Other (please specify)
Thank you for your interest! Please press "done" to complete the survey and your coach will contact you soon!
Survey Powered by:
SurveyMonkey.com
"Surveys Made Simple."
Javascript is required for this site to function, please enable.