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2021 4given T Shirt
$12.00

Pre Questionnaire Form

Order Number

(On a scale of 1 to 10 with 1 being least and 10 being most, please rate the following on each)

How would you describe your academic strength level? *

1 2 3 4 5 6 7 8 9 10

How would you describe your commitment level to learning? *

1 2 3 4 5 6 7 8 9 10

How would you describe your personal discipline for school? *

1 2 3 4 5 6 7 8 9 10

How would you describe your support from family? *

1 2 3 4 5 6 7 8 9 10

How would you describe your support from friends or others? *

1 2 3 4 5 6 7 8 9 10

Have you set goals for school to achieve your desired outcome? *

1 2 3 4 5 6 7 8 9 10

Are you prepared to sacrifice your time for a good GPA? *

1 2 3 4 5 6 7 8 9 10

I enjoy on-line classes with little oversight or supervision. *

1 2 3 4 5 6 7 8 9 10

For hands on with the teacher, I enjoy classroom learning more. *

1 2 3 4 5 6 7 8 9 10

How confident are you about your writing ability for school? *

1 2 3 4 5 6 7 8 9 10

Do you know what your “Major” will be in school? *

Yes Not Yet

Would you like an academic coach your 1st year of college? *

Yes Unsure

Do you have a talent or gift (music/instrument/sport/etc.)? *

Yes Unknown

Do you have an exit plan if school does not work out for you? *

Yes No

Are you (1) a local student or (2) an out of state student? *

1 2

First Name *

Last Name *

Email Address *

Phone Number *

In one or two words describe to us who you are *

Example: I am… Confident & Self disciplined

Thank you for taking our questionnaire and for your interest in our program. Someone from our team will reach out to you within 48 hours to discuss your responses and to see if you have any questions.

Best Regards!
First Class Team

2021 4given T Shirt

Pre Questionnaire Form