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Now that the college process has wound down, we want to thank you so very much for all of your help with [our daughter] and with us. You gave us all wonderful advice and guidance, and steadied many nerves along the way. Equally important, you offered her a sounding board and created for us a channel of communication that was far more productive than we would have had on our own.

—Parents (mom an education professor)


Our daughter was an accomplished procrastinator, but she met her match in the three of you. She of course ignored the pleas of her parents to work on her application and essay. But your meetings, emails, and phone calls were somehow harder for her to ignore… The three of you played a crucial role in helping our daughter to craft a really good college essay. I was impressed at how you made excellent suggestions but carefully avoided the temptation to simply write the essay for her. It remained her essay, but it ended up being a much clearer and more engaging expression of her than it would have been without your help…With your help, the stress on our daughter and on us was lessened, and she had a much better chance that colleges would see what a great kid she is.

— Parents of Dartmouth student

College Circuit Parent Questionnaire

Student/Client Information

If you'd like a copy for your records, please print from your browser before clicking "Submit" at the end of this form.

Student's Name
Student's Address
  City State Zip
   
Father's Name
Father's Address
  City State Zip
   
Mother's Name
Mother's Address
  City State Zip
Phones / Email  
Student:    
Home
Cell
Work
Fax
Email
Father:    
Home
Cell
Work
Fax
Email
Mother:    
Home
Cell
Work
Fax
Email
Education & Occupations
Current School
  Grade Graduation Year
Student's Birthdate Age
Father's College /
Grad School
Father's Occupation
Mother's College /
Grad School
Mother's Occupation
Miscellaneous
Names, ages, and schools of brothers and sisters
Who referred you to us?
Student's Start Date

 

Parent Questionnaire

  1. Please use several adjectives that you believe would best describe your child.

  2. Is there a particular learning environment in which your child seems to thrive?

    Does poorly in?

  3. Are there any schools you would particularly like your son/daughter to consider? If so, why?

  4. Are there any schools or specific places you will not allow him/her to consider? If so, why?

  5. Will you need financial aid to attend? Yes No

    A private college ($40,000 plus expenses per year or more)
    An out of state public university ($25,000-40,000)
    An in state public university living on campus ($15,000-25,000)

  6. Has your child ever been identified as having a learning disability? ADD/ADHD or even consulted a psychologist? Please explain.

  7. Has your child ever been suspended, expelled or put on probation since 9th grade?

  8. Is there anything else we should know about your child or you that would help us assist you in this process?

  9. Do you have any differences of opinion with your son/daughter/other parent regarding college? (location, expectations, cost, type of college, etc.)

  10. What is the most important to you in the college choice?
    (Rank 1-5, with 1 being the highest)

Fit
Affordability
Location
Perception (U.S. News Rank, "Name," Reputation)
Special Interest (academic, sport, LD Support, talent, etc.)

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