Student Information Form

Jason Coates

Education Consultant, College Counselor and Student Coaching
Student Information Form

There are only 5 required questions on this form, which will allow me to contact you to schedule an information session. However, please provide as much info here as possible so I can get back to you with the best strategy to start your college plan. I am looking forward to hearing from you.
Student Name *

First Name Last Name
Student Mobile *

Country Phone Number
Student Email *
example@example.com
Date of Birth *

Month Day Year
Date of secondary school graduation *

Month Day Year
Date of graduation
Parent 1 Name

First Name Last Name
Parent 1 mobile #
Parent 1 email
example@example.com
Parent 2 Name

First Name Last Name
Parent 2 mobile #
Address

Street Address

Street Address Line 2

City

Postal Code
Current School
Name of School
Grade in School
current year
Current GPA
grade unweighted point average (if known)
Most Recent Academic Grades

Letter Grades or Number Grades
English Grade
Math Grade
Science Grade
Language Grade
PE Grade
Other Grade
indicate subject and grade
Other Grade
indicate subject and grade
Extracurricular Activities

how do you spend time outside the classroom? List significant activities by year.
Grade 9 Activities
Grade 10 Activities
Grade 11 Activities
Grade 12 Activities
Testing Information

Insert PSAT / SAT or Pre-ACT/ ACT scores (if known)
SAT Score (Reading)
indicate date taken or planned
SAT Score (Math)
indicate date taken or planned
SAT Score (Writing)
indicate date taken or planned
SAT SUBJECT TEST
indicate subject, crore and date
SAT SUBJECT TEST
Indicate subject, crore and date
ACT Composite Score
indicate date taken or planned
ACT Score (eng)
ACT Score (math)
ACT Score (science)
ACT Score (reading)
ACT Score (writing)
College Planning Goals
List the specific College and/or University names that you are interested in.
What is your intended area of study/major?
List the geographical areas or specific US states of interest (Northeast, South, West Coast, etc)
Preferred College Size

Small (less than 5000 students) medium (5000-10,000 students) large (10,000+ students)
Preferred College Setting

Urban / City (200,000+ pop) Suburban (25,000-200,000 pol) Rural (25,000 pop)
What are your education goals for the next year?
How would you define success in working with FrontYard Consulting?
Should be Empty:

Jason Coates

Student Information Form

Current School

Most Recent Academic Grades

Extracurricular Activities

Testing Information

College Planning Goals