EmailMeForm
SQQ - Student Qualification Questionnaire
Information used for interview ONLY * and is confidential. If you prefer to print a hard copy to scan or fax,
CLICK HERE
Student Name
*
First
Last
Student Date of Birth
*
MM
/
DD
/
YYYY
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Student Phone
###
-
###
-
####
Student Email (not school)
*
Not an email assigned by your school
High School Graduation year
*
i.e. 2024
School Attending Now
*
GPA - 4.0 Scale Only
*
Not Weighted for Advanced Placement or honors. Maximum GPA is 4.0
Middle School Grade Now
i.e. grade 6,7,8
High School Grade Now
i.e. grade 9,10,11,12
College Undergraduate Year
i.e. Year 1,2,3, etc.
College Post Graduate
Describe your current status
Interest Field or career goals
*
Colleges of Interest
*
Sports interest? What Sports?
Jobs - Employment
ACT/SAT Test Scores
If none enter "0"
Applicant 1 Full Name
*
Applicant 1 Email
*
Applicant 2 Full Name
Applicant 2 Email
Applicant 1 Phone
*
###
-
###
-
####
Applicant 1 Occupation
Applicant 2 Phone
###
-
###
-
####
Applicant 2 Occupation
Available Funds for College
Community Volunteer
Community Volunteer Email
Email of the community volunteer who contacted you
Comments
*
Submitted on a Secure Server
Signature - you may use your email
*
Today's Date
*
MM
/
DD
/
YYYY