Student Intake Form printable pdf download

Appointment Date/ Time/ With: ______________________________________________________________________________________________

Intake Form

SIDE ONE

Please bring your FSA ID as well as your most current bills and statements to your

individual session.

Before your scheduled appointment please fill out Section 1,

and

of this form.

Section 1: Your personal information

Name:__________________________________________________

Student ID:________________________________________________

Phone: _________________________________________________

Email: _____________________________________________________

Current Class Standing:



Freshman



Sophomore



Junior



Senior



Post Bac.



Grad. School



Alumni



Previous Student



Prospective Student



Other_________________

Section 2: Please check all that apply to you.



I need help understanding how to access Federal Aid



I need help managing my checking and savings or

credit card accounts





I don’t understand my Financial Aid Award Package



I have paid a bill late in the last 6 months





I am unsure what types and amounts of student loans



I am unsure how I will pay rent next month

I have



I feel broke all the time





I need help understanding my repayment amounts and



I have bounced a check in the last 6 months

options for my Federal Student Loans





I have gotten a call from collections in the past year



I am interested in pursuing student loan forgiveness



I have moved in the last 6 months



I am worried I might not be able to pay back my loans





I have NOT checked my credit report in the last year



I have little to no emergency savings

Other:______________________________________________



I would like to build a budget

Section 3: Please answer the following questions where one is strongly disagree & five is

strongly agree.

Strongly Disagree

Strongly Agree

I feel confident in my financial skills.



I have a plan for handling my finances.



I know how to get accurate financial information.



SIDE TWO FOR OFFICE USE ONLY

Student Intake Form

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