Questionnaire - Atlanta College Counseling

Name *

First

Last

Email *

Phone Number

Name of High School

City, State

What activities do you do at school?

What activities do you do outside of school?

Include family responsibilities, home responsibilities, a job, religious work, tutoring, community service, etc.

What do you do when you have a completely free night (no homework, no family events)?

Out of all of the different things you do, what kind of things do you do that make you completely lose track of time?

This can be babysitting, drawing, video games, horseback riding. It can be working math programs or programming. Or reading. List a few if there are a few things like this. We call this being in “flow” - where you are so engaged with what you are doing, it’s hard to distract you from it.

Do you have anything like this in your life now?

Do you feel like you have developed an internal code that helps you know how to react to different situations in life?

What are some of the important parts of this code that you are willing to share?

Have these been part of your internal code since you were a kid, or did some event happen, or some thought process take place, that made you decide to develop some rules or tenets to help guide your decision-making?

Describe a few events that have been most impactful in your life.

Describe any events you are willing to share that might have happened that made you question what you thought before about the world and your role in it.

Think back on the past month. What is the weirdest or most interesting thing that you thought about, heard about, or that happened to you?

Interests: Please check the boxes next to areas you might be interested in. There are no wrong answers here! This will help us explore possible passions.

Please list any interests not listed above:

Confidential Questionnaire