PATHFORWARD LEARNING

Personalized guidance. Clear next steps. A path forward.

Student & Family Intake Form

Help us understand where you are now and where you want to go. Fields marked * are required.

Privacy reminder: Please do not submit Social Security numbers, banking passwords, FSA ID passwords, school portal passwords, or other account credentials.

1. Student Information

Student Full Name * Preferred Name Date of Birth Student Email * Student Phone Current School * Current Grade / Year * Expected Graduation Date

2. Parent / Guardian Information

Is the student under 18? * Parent / Guardian Name Relationship to Student Parent / Guardian Email Parent / Guardian Phone Preferred Contact Method

3. What Brings You to PathForward?

College selection / college list College application planning FAFSA / financial-aid guidance Scholarship strategy Academic planning Community college / university transfer planning Career / major exploration Student success / accountability

Other

4. Student Goals

What are your top 1–3 education or career goals? * Colleges / programs currently considering Majors / career fields currently considering

5. Current Situation

Current GPA (optional) SAT / ACT scores, if applicable (optional) Important upcoming deadlines What feels most confusing or stressful right now? * What would make this engagement successful for you? *

6. Communication

Email Phone Text (when offered)

Best days / times to contactHow did you hear about PathForward Learning?

7. Acknowledgment

I understand that I should not submit passwords, Social Security numbers, banking credentials, FSA ID passwords, or other sensitive account credentials through this form. I confirm that the information I provided is accurate to the best of my knowledge. Full Name *

PathForward Learning • pathforwardlearning.com • info@pathforwardlearning.com • 252-679-6945