Please complete the following three sections: Student Information, Student Questionnaire and Parent Questionnaire. Your place in a workshop will be secure once you have submitted these forms AND your deposit.
*STUDENT INFORMATION
First and last names of student:
First and last name(s) of parent(s):
Street Address:
City and Zip:
Home phone number (or primary parent cell #):
Parent email address(es):
Student email address:
Student cell phone #:
Student’s high school:
If Berkeley High, name of small school:
Which workshop would you like to attend:
First choice session:
Second choice session:
Do you have access to a laptop computer for the second part of the workshop? (This is NOT a requirement of the workshop. Laptops will be provided for students who cannot bring one.)
How did you hear about composed?:
While there is no commitment, it is useful for us to know if students think they will continue working with us for additional one-on-one or small group support following the workshop. Do you think you will return for additional college essay support? Note as many as apply:
Yes for all personal statement and supplemental essay work.
Yes for the personal statement(s).
Maybe.
I don’t think so.
No.
PLEASE COMPLETE THE FOLLOWING
QUESTIONNAIRES (one for student and one for parent(s)):
STUDENT QUESTIONNAIRE:
*Please list all work, sports, activities, clubs, service projects, and awards/honors from the last two years (both in and out of school):
*If a college application required you to write about an extracurricular activity, work experience or hobby, what would you write about and why? (And yes, most do.)
The college applications have a section entitled “Additional Comments.” Oftentimes, this space is used to explain something on your academic record or in your personal life that is not explained elsewhere (i.e. vast difference between test scores and grades, extended illness, one really low grade among consistently high grades, learning differences, death/illness in the family, etc.) Might you use this space to explain something? If so, briefly describe here.
*If a college application required you to write about an academic experience (project, lab, field trip, paper, exam, etc.) or class, what would you write about and why? (And yes, some do.)
Please note today’s date here: ______
Now, highlight or underline which phrases best define where you are in your college application process. Please note as many as apply.
I have no idea where I am going to apply.
Schools to which I may/am likely to apply:
My first choice school(s) is/are:
I plan to apply Early Decision (binding) or Action (non binding) to ______
I will get college application support from:
my school’s college counselor
my parent(s) (which one: ___ )
a private college counselor (name:contact email: )
Please highlight or underline which apply…
I will be using the following:
University of California application
Other State University applications (i.e. U. of Oregon, U. of Washington, etc.)
The Common Application (most private schools)
California State University application
Have you been in touch with any coaches and/or are you considering schools for athletics?
If yes, which sport and for Division I, II or III athletics?
*What five words or phrases would you or others use to describe you? (Note: These do not have to be adjectives! Also, this is sometimes an application question, so might as well think on it now!)
*Many students come to us with no idea of his/her topic(s) for their essays. This is to be expected! There is no right or wrong, and there is no commitment to use anything you write here, however what could you write about for a personal statement (an essay that shows your best qualities and characteristics)? Name as many as you would like with as little or as much explanation as you wish:
Any other information that might be helpful to us in working with you through the essay process?
*I have read, understand and agree to the policies of the workshop, including cancellation and no show policies. Please initial here:
PARENT QUESTIONNAIRE:
*Describe your child’s greatest personal strengths. Feel free to give examples.
*Describe your child’s strengths as a student.
*Describe what you anticipate to be your “working relationship” with your child as it relates to the college essays (i.e. you’ll see every draft, you’ll be a final proofreader, you’d like to be involved all the way through but there’s no chance your child will share, you’ll read it once it’s submitted).
If there are any circumstances that you feel have negatively affected your child’s academic record, please describe them here.
If you could decide what topic or topics your child would write about for his/her Personal Statement, a piece that meant to convey his or her strengths through a story or stories, what would you choose?
Is there anything that you would like us to know about your child and/or your family circumstances as it relates to the college application process?
*It is rare that we refer to the questionnaires in meetings. However, when a student is “stuck”, your answers can be quite useful. Is there anything on this questionnaire that you would prefer we didn’t share with your child?
To complete your student’s registration, please send a $170.00 deposit to
Nina Cohen
1542 Blake Street
Berkeley, CA 94703
The remaining $300.00 for the workshop is due at the group meeting.
You will receive a confirmation email of receipt of payment and workshop date within two weeks of deposit receipt.
*I have read, understand and agree to the policies and fees of the workshop, including cancellation and no show policies and deposit/payment information. Please initial here: