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Date
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High School you attend
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AVHS
DWHS
EHS
HHS
KHS
LHS
LnHS
PHS
QHHS
RREXHS
Adult Ed
Counselor
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Ms. Como
Ms. Duffy
Mr. Haggard
Ms. Hale
Ms. Hong
Mr. Prewitt
Ms. Ryan
Ms. Rose-Cockrell
Ms. Sampson
Ms. Van Zandt
Meeting Type
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Individual (After School/Saturday)
Group (After School/Saturday)
Parent (After School/Saturday)
During HS hours
AVC ID # (900-XX-XXXX)
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Last Name
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First Name
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Grade
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12
11
10
9
N/A
Graduation Year
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2018
2019
2020
2021
Interest Level
High
Medium
Low
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Desired Start Date @ AVC
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Spring 2018
Summer 2018
Fall 2018
Best Contact #
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Preferred Email
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Have you applied?
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Yes
No
Have you completed the assessment?
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Yes
No
Have you completed the online orientation?
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Yes
No
Have you had your Education Plan reviewed?
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Yes
No
What is your education goal?
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A- Earn AA & Transfer to 4yr
B- Transfer to 4yr w/o AA
C- Earn AA w/o transfer
E- Earn vocational certificate w/o transfer
F- Formulate career goals
G- Prepare for new job/career
L- Complete credits for HS diploma
O- Summer classes only
Attending other college or university
What is your intended major?
Your answer
Are you interested in any of the following resources? Check all that apply.
CalWORKs
EOPS & Care
First Year Experience
Honors Program
Law Scholars
OSD (Office for Students with Disabilities)
STAR Support Program
Have you registered for classes?
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Yes
No
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