Complete this College Selection Form and click on the Submit Information button below.  Required information is identified in red.  This will provide our organization with the information needed to evaluate you or your students qualification for our process and service.

Student's Name:	
Grade Level:		
GPA:			

SAT Scores:		
ACT Scores:		

Parents' Email:		
    Work Phone:		
    FAX Number:		

Address:			
City:			
State:			
Zip Code:		
Phone Number:		
Student E-Mail:		


College Interests:
1.		2.	
3.	  4.	

Major in College?		
Size of College?		
Geographic Region?	

Special Interests? (i.e., sports, music, art, etc.)


Additional Comments:


 I have read The Circle of Neighbors Promise of Value.

 I have viewed the Student Overview online presentation.

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