Holistic Advising Intake Form Please specify all information you may have reviewed to inform your student advising. Question Title * 1. Student Information Student ID Ethnicity Gender Age Full-time/Part-time student Student work status/Full-time or Part-time? Parent education/ two or four year degree? Caretaker Financial Aid Question Title * 2. High School Information High School (or equivalent) year of completion High School GPA Did not obtain/have access to information (enter: NA) Question Title * 3. Grade in last high school English Class English III English IV Did not obtain/have access to information (enter: NA) Question Title * 4. Grade in last high school Math Class Algebra I Algebra II Did not obtain/have access to information (enter: NA) Question Title * 5. Enter most recent TSI Assessment Scores Math Multiple Choice Score Math DE Diagnostic Score Math ABE Diagnostic Score Reading Multiple Choice Score Reading DE Diagnostic Score Reading ABE Diagnostic Score Writing Multiple Choice Score Writing Essay Score Writing DE Diagnostic Score Writing ABE Diagnostic Score Question Title * 6. Near college ready in Math? Yes No Question Title * 7. Near college ready in Reading/Writing? Yes No Question Title * 8. If your test score is within 5 points of the required college readiness score, are you interested in completing a one-page assessment that may allow you to bypass Developmental English? Yes NO Question Title * 9. If your test score is within 5 points of the required score, are you interested in receiving optional lab support by voluntary, scheduled appointments? Yes No Question Title * 10. Retest Yes No Question Title * 11. Did not obtain/have access to TSI Assessment scores Math Reading Writing Essay Question Title * 12. ESOL Scores Test Date Reading test score Writing test score Listening test score Grammar test score Question Title * 13. Which of the following describes student major? STEM Non-STEM Undecided Question Title * 14. Transportation Available Unavailable Did not obtain/have access to information Question Title * 15. From all the factors you reviewed, indicate the main three that influenced your decision about student placement. TSI Assessment Scores High School Information College Course Work Workplace Experience Noncognitive Factors Student work status Caretaker for children Schedule conflict Other (please specify) Question Title * 16. Student Course Placement: MATH INRW Please select course and section number from the drop down menu. MATH 0115 MATH 0120 MATH 0140 MATH 0215 MATH 0115/0215 MATH 0300 MATH 0315 MATH 0340 MATH 0420 MATH 1342 SPC MATH 1314 SPC Please select course and section number from the drop down menu. MATH menu INRW 0310 701 INRW 0310 001 INRW 0310 002 INRW 0310 003 INRW 0310 004 INRW 0310 005 INRW 0310 006 INRW 0310 007 INRW 0310 008 INRW 0310 081 INRW 0310 082 INRW 0310 009 INRW 0310 010 INRW 0320 701 INRW 0320 001 INRW 0320 002 INRW 0320 003 INRW 0320 004 INRW 0320 005 INRW 0320 006 INRW 0320 007 INRW 0320 008 INRW 0320 081 INRW 0320 082 INRW 0320 009 INRW 0320010 ENGL 1301 NCBO ENGL 2307 NCBO Please select course and section number from the drop down menu. INRW menu Question Title * 17. Advisor ID: Question Title * 18. Length of advising session: Question Title * 19. Student Referred to TRIO SSS Advisor: Yes No Done