GEAR UP Wyoming Student Intake Form - Eastern Wyoming College - Eastern Wyoming College

Name*

First

Last
Email*

Enter Email

Confirm Email
Today's Date*

MM slash DD slash YYYY
Grade*
- 7
- 8
- 9
- 10
- 11
- 12
How did you hear about GEAR UP? Select all that apply.*
- Parent(s)
- Teacher(s)
- Other school staff
- Other (ad, event, etc)
- Friend(s)
- Counselor
- GEAR UP staff
Why did you decide to join GEAR UP? Select all that apply.*
- I have friends who are participating
- To get help choosing a college
- It was recommended to me by an adult
- To get help preparing for college
- Academic tutoring and support
- To find out how to pay for college
- Career exploration and advising
What is the highest level of education you expect to complete?*
- GED
- Certificate
- Bachelor’s (4-year) degree
- Not sure
- High school diploma
- Associate (2-year) degree
- Graduate degree (master’s or doctorate
Do your parents or guardian(s) expect you to go to college?*
- Yes
- No
- Not sure
Do you think you will be able to afford to attend a public 4-year college or university*
- Yes
- No
Do you think you will be able to afford to attend a 2-year college/community college*
- Yes
- No
Has anyone talked to you about the availability of financial aid to help you pay for college?*
- Yes
- No
- Not sure
Do you know how to qualify for the different levels of the Hathaway Scholarship?*
- Yes
- No
- Not sure
Do you know what the Free Application for Federal Student Aid (or FAFSA) is?*
- Yes
- No
- Not sure
What challenges are you currently facing at school? Select all that apply.*
- Time management
- Fitting in at school
- Study skills
- Getting along with teachers and school staff
- Transportation to school
- Getting along with other students
- Focus/concentration issues
- Language barriers
- Academic challenges
- Fitting in at school
- Getting along with teachers and school staff
- Getting along with other students
- Feeling anxious, depressed, or overwhelmed
- Affording school supplies or other financial concerns
Please rate each of the following, based on how helpful it would be to participate in during this school year. Select only ONE per row.
Tutoring/homework assistance*
- 1 – Not helpful at all
- 2
- 3
- 4
- 5 – Most helpful
Help in organization, time management, study skills*
- 1 – Not helpful at all
- 2
- 3
- 4
- 5 – Most helpful
Group meetings at school with other GEAR UP students*
- 1 – Not helpful at all
- 2
- 3
- 4
- 5 – Most helpful
One-on-one meetings with GEAR UP staff*
- 1 – Not helpful at all
- 2
- 3
- 4
- 5 – Most helpful
Enrichment activities (e.g., Robotics, Saturday Academy, book clubs)*
- 1 – Not helpful at all
- 2
- 3
- 4
- 5 – Most helpful
Academic plan/advising*
- 1 – Not helpful at all
- 2
- 3
- 4
- 5 – Most helpful
Information on how to get into college*
- 1 – Not helpful at all
- 2
- 3
- 4
- 5 – Most helpful
Information on how to pay for college*
- 1 – Not helpful at all
- 2
- 3
- 4
- 5 – Most helpful
College campus visits*
- 1 – Not helpful at all
- 2
- 3
- 4
- 5 – Most helpful
Career exploration and advising*
- 1 – Not helpful at all
- 2
- 3
- 4
- 5 – Most helpful
Review of college and/or financial application(s) (checking for incomplete or incorrect information)*
- 1 – Not helpful at all
- 2
- 3
- 4
- 5 – Most helpful
Summer enrichment academies*
- 1 – Not helpful at all
- 2
- 3
- 4
- 5 – Most helpful
GEAR UP summer camp at University of Wyoming*
- 1 – Not helpful at all
- 2
- 3
- 4
- 5 – Most helpful
What extracurricular activities are you participating in? Select all that apply.*
- Publications (e.g., newspaper, yearbook)
- Service clubs (e.g., Habitat for Humanity)
- Performing arts (e.g., band, drama, debate)
- Church group or community group
- Athletics (e.g., individual and/or team sports)
- Interest clubs (e.g., chess, environment, language)
- Academic clubs and honor societies
- Part-time job
- Student government
- Full-time job
- Vocational or professional clubs (e.g., 4-H, FFA, FBLA)
- do not participate in any activities right now.
How would you prefer we contact you? Select all that apply.*
- Email
- Text message
- Phone call
- Mail
- Social media
When would be the best time to meet with you? Select all that apply.*
- Mornings before school
- Lunchtime
- Right after school
- Evenings
- Weekends