CAFÉCOLLEGE ADVISING REQUEST FORM

Cafécollege is offering phone/virtual advising to address the need for college access services in our community during our mandated closure. Please complete as much information as possible in the form below.

If you are a parent requesting an advising session for your child please put student information in the form.

Personal Information

First Name

Middle Name

Last Name

Date of Birth

Personal Email

Student Cell Phone

Social Security Number

Gender

Ethnicity

Race

Are you a dependent of a U.S. Veteran or current U.S. Military Member?

Are you currently serving or have you ever served in the U.S. Military?

School Attending

Current Educational Institution

High School

High School Graduation Year

College/University you are attending or plan on attending:

Do you have previous College Credit hours?

Previous college credits from what College/University?

Home Address

Street Address

City

State

Zip Code

Parent / Guardian (P/G) Information

P/G Last Name

P/G First Name

P/G Email

P/G Cell Phone

P/G High School Diploma?

P/G College Degree?

Visit Information:

Preferred Method of Contact (select one)

Best time to contact

Do you have a preferred cafécollege advisor?

Who referred you to us?

Other Referral

What other questions do you have?

Limited to 250 characters

Student Signature (Type your Name)

Hidden Fields

High School Account ID

StateCode

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Contact Information