Educational Consultant's Form
Apply to Become a Consultant
Personal Information
First Name:
Last Name:
Institution:
Title:
Contact Information
Address 1:
Address 2:
City:
State:
Zip (5 digits):
When entering your phone and fax numbers, use the following format:
803-777-5555
.
Phone:
Fax:
E-mail:
Career and Education Information
In what year did your higher education career began?
In what year did you began your current position?
In what year did you originally become an educational consultant?
Date of last Educational Consultant Training: (format date as
MM/YYYY
)
Highest Degree Earned: (Bachelors, Masters, Specialist, Doctorate)
Bachelors
Masters
Specialist
Doctorate
List the five most recent Educational Consultant presentations given. Include the name and date of the presentations. Enter the date using the format MM/YYYY
.
Presentation #1:
Date of Pres. #1:
Presentation #2:
Date of Pres. #2:
Presentation #3:
Date of Pres. #3:
Presentation #4:
Date of Pres. #4:
Presentation #5:
Date of Pres. #5:
Previous institutions (if any):
Your answer to each of the next two questions is limited to 500 characters. Only the first 500 characters of each answer will be kept.
Areas of expertise within Higher Ed & College Planning :
Why do you want to be an educational consultant?
Please rate your level of familiarity with the following:
(5-very familiar, 3-somewhat familiar, 1-not familiar)
College Foundation of North Carolina
5
4
3
2
1
South Carolina AIM College
5
4
3
2
1
College Planning
5
4
3
2
1