Student Intake form PART 2

 
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1. What is your full name?
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2. Do you think you will be able to afford to attend a:
YesNo
Public 4-year college or university
2-year/community college
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3. How difficult do you find the following subjects?
Very DifficultSomewhat DifficultNot DifficultEasy
Reading
Writing
Math
Science
Social Studies
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4. Please rank each of the following activities we could provide you this school year:
1 Not helpful at all2345 Most helpful
Tutoring/Homework Assistance
Reading support
Help in organization, time management, and study skills
GEAR UP meetings at school
Individual meetings with GEAR UP staff
Enrichment activities (for example, Robotics, Saturday Academies, Book Clubs)
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5. Please rank each of the following activities that will help you get ready for college.
1 Not helpful at all2345 Most helpful
Academic plan/advising
Information on how to get into college
Information on how to pay for college
College campus visits
Career exploration and advising
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6. IF you are a junior or senior in highschool:
YesNo
Have you taken the ACT?
Have you completed the FAFSA?
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