Lewy College Consulting, LLC
1066 NW Stannium Rd. Bend, OR 97701
541.647.0893~portelewy@gmail.com~www.collegeconsultingbend.com
Please complete and return this questionnaire at least three days prior to our first meeting. Please
bring along your most recent high school transcript and any available test score reports.
STUDENT QUESTIONNAIRE
Student:
Name
Address
Phone
Email
Birthday
Mother:
Name
Address
Phone
Email
Occupation
Employer
Colleges attended
Degrees earned
Father:
Name
Address
Phone
Email
Occupation
Employer
Colleges attended
Degrees earned
1
High School & Academic Information
High school
Year of graduation:
H.S. counselor
Other high schools
attended / dates
Cumulative GPA
AP / IB courses taken
Foreign language
courses taken
Current years courses –
all terms
Senior year courses (if
applicable)
PSAT Scores
CR:
Math:
Writing:
SAT Scores
Date:
Comp:
CR:
ACT Scores
Date:
Composite:
Math:
Writing:
What are your favorite school subjects and why?
What subjects do you least enjoy and why?
How do you learn best? Are you an independent learner or do you need direction? Do you prefer to
work alone or in teams? Who was your favorite teacher and why? Do you feel you learn best in big
settings, like lecture halls, with no pressure to actively participate or smaller classes where you are
expected to contribute to the discussion?
At what level of academic challenge do you work best? How do you respond to competition and
academic pressure? Do you prefer to work in a collaborative atmosphere?
2
How do you interact with others? Are you an initiator or a follower? What causes stress in your life
and what results in enjoyment and productivity? Are you open and tolerant of differences, or do
you prefer to be with people like you?
Name three words your parents would use to describe you; name three words your friends would
use to describe you.
Name a few of your favorite books, magazines, TV shows, movies, websites.
What are your goals, dreams, and/or visions for your future?
List your extra-curricular activities. Specify years of involvement and positions of leadership
or responsibility, and indicate which ones are most important to you:
School Activities/Clubs:
Athletics:
Volunteer / Community Service:
Arts:
3
Work & Summer Activities:
Other Activities:
Please note any other significant information you want to share. This could include strengths, talents,
interests not mentioned above, a learning difference or special learning style, or concerns,
problems, or weaknesses you think I need to consider in matching you with appropriate colleges
and possible scholarships.
COLLEGE QUESTIONNAIRE
Highlight or circle your choices:
College size:
Small: 1000-3000
Medium: 3000-8000
Large: 8000+
Geographic location:
Pacific Northwest / California / Rocky Mountains / Southwest / South / Midwest / Mid-Atlantic /
New England
College setting:
Urban / Suburban / Small city / Rural
College Atmosphere:
Traditional / Conservative / Liberal / Middle of the Road / Alternative
Academic challenge:
Intellectual-scholarly emphasis / academic-social balance
Religious affiliation: Yes / No / Not sure
Greek life: Yes / No / Not sure
ROTC: Yes / No / Not sure
Will you apply for financial aid: Yes / No / Not sure
4
Intended major or possible majors if undecided:
Careers or occupations of interest:
Sports you want to participate in and possible level of competition:
Other programs or activities you want available to you?
List any colleges or universities you are presently considering.
Do you have any family legacies at certain institutions? If so, which ones?
Please mention anything else I should be aware of?
Do you have any brothers or sisters? If so, what are their names and ages? If they are already in
college, where do they attend?
5