Student's Name Date (mm/dd/yy)
Instructions: Please check the appropriate response.
1. Have you talked with someone about college admissions?
Yes No 2. Do you have enough information about college preparation?
Yes No
3. How much education would you like your child to complete? (Check one)
Less than high school
High School only
Certificate (Vocational school)
Associate degree (two years college)
Bachelor degree (four years college)
Graduate or Professional degree (six years or more college)
4. What is the main reason your child would not continue education after High School? (Check one)
NA/Child will continue Cost
Desire to work Poor grades
Not interested Join Military
Family issues Other
5. Are you familiar with college entrance requirements for: (check all that apply)
2-year college 4-year college Vocational, trade or business
6. Have you talked with your child about attending college?
7. Have you talked to someone about the availability of financial assistance?
8. Do you think your child will be able to afford to attend a four-year college or university?
Yes (definitely/probably) (doubt it/definitely not) Not Sure
9. Have you or your child participated in GEAR UP II events?
10. How much do you think the average cost is to attend a four-year public college for one year?
(Please guess if you’re not sure) $