Personal Information

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* 1. Information Session Date

Date

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* 2. Name:

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* 3. Student ID#:

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* 4. Cell Phone Number

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* 5. Alternate Phone Number:

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* 6. Personal Email Address:

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* 7. Student Email Address:

What is the 1st Term & Year you enrolled at Columbia College?

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* 8. Term:

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* 9. Year:

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* 10. What is your projected Graduation Date from Columbia College?

Date

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* 11. What Academic and/or Personal Growth goals do you want to set for yourself as part of the TRiO SSS Program?

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* 12. What is your Major at Columbia College?

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* 13. What will be your Major at University?

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* 14. What is your Career Goal?

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* 15. What is your Counselor's name (if you have one)?

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* 16. Have you created an Educational Plan with an Academic Counselor?

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* 17. What is Educational Goal(s) listed on your Ed plan currently. (check all that apply)

T