High School Questionnaire

If you would like to provide member colleges and universities with additional information about your accomplishments, please complete this form.   Remember to use complete sentences. Reread your answers before submitting to the Ventures Scholars Program. College and university admissions personnel will notice your mistakes!

Date:
First Name:
Last Name:
Address:
City:
State:
Zip Code:
Phone: (include area code)
Email:
Gender:	Male   Female
Ethnicity:
Date of Birth:	Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1984 1985 1986 1987 1988 1989 1990
I will graduate high school in:
	2005
	2006
	2007
High School:
Where is your high school located?
City:
State:
Underrepresented or First-Generation College-Bound Student (check all that apply)
	I am a member of an underrepresented group. (African American or Black, Native American or Alaskan Native, Mexican or Mexican American, Hispanic, Latino, or Mainland Puerto Rican)
	I am a first-generation college-bound student whose parents/guardians have no education beyond high school.
Please answer the following questions in complete sentences. You may want to type the your responses in another document and paste them in the windows. Be sure you proofread before submitting.
What is your career interest? What is your unweighted grade point average? A+ (97-100) A (93-96) A- (90-92) B+ (87-89) B (83-86) What is your class rank? out of students. What did you score on the PSAT or PLAN exam(s)? PSAT Math           47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 PSAT Verbal           47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 PLAN Composite           16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 If you have taken the SAT or ACT, please provide your scores. SAT Math           200 210 220 230 240 250 260 270 280 290 300 310 320 330 340 350 360 370 380 390 400 410 420 430 440 450 460 470 480 490 500 510 520 530 540 550 560 570 580 590 600 610 620 630 640 650 660 670 680 690 700 710 720 730 740 750 760 770 780 790 800 SAT Verbal           200 210 220 230 240 250 260 270 280 290 300 310 320 330 340 350 360 370 380 390 400 410 420 430 440 450 460 470 480 490 500 510 520 530 540 550 560 570 580 590 600 610 620 630 640 650 660 670 680 690 700 710 720 730 740 750 760 770 780 790 800 ACT Composite           10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 34 34 35 36 Write about yourself and your achievements.   You can include information about your involvement in clubs, part-time jobs, volunteering, leadership roles, honors, sports, etc. Write about extenuating circumstances that would help a member institution or association learn about your life. (i.e. high achieving student in a low performing high school, working a part-time job to help your family, etc.)
List the math and science courses you are currently taking in high school.
List the math and science courses you have completed in high school.
What size school are you interested in attending? (check all that apply)
	Less than 1,000 students
	1,000 - 2,500 students
	2,500 - 5,000 students
	5,000 - 10,000 students
	10,000 - 15,000 students
	More than 15,000 students
	Not a factor
	Unsure
What type of area are you interested in attending school in? (check all that apply)
	Rural location
	Suburban location
	Urban location
	Not a factor
	Unsure
In what regions are you interested in attending college or university? (check all that apply)
	Middle States [DC, Delaware, Maryland, New Jersey, New York, Pennsylvania]
	Midwest [Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, West Virginia, Wisconsin]
	New England [Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont]
	South [Alabama, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia]
	Southwest [Arkansas, New Mexico, Oklahoma, Texas]
	West [Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, Oregon, Utah, Washington, Wyoming]
	Not a factor
	Unsure
What other characteristics are you looking for in a college or university? (i.e. co-ed/single-sex, HBCU, ROTC programs, religious affiliation, extracurricular activities, sports, research opportunities, etc.)
What other questions would you like to ask the member colleges/universities or professional associations?