Registration & Payment – College Services | One on One College Consulting

Student Information

Student Name*

First Middle Last Suffix

Student Nickname

Type of Student*

Year of Graduation*

Date of Birth*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Student Cell Phone*

Student Email*

Enter Email Confirm Email

Please list colleges you may be interested in exploring (if none, write N/A):*

In order to create the best match with an admissions coach, please share your student's strengths and areas of opportunity.*

What are your student's hobbies and interests?*

Is your student on an IEP or 504 plan? If yes, please describe the accommodations he/she receives.*

Please share any additional information you think would be beneficial for matching your student.

Please select the general times you are available for meetings with One-on-One:*

Current School*

Previous High School(s) Attended - Please list dates and grades of attendance (if applicable).

Please upload your most recent Unofficial Transcript (PDF).

Max. file size: 200 MB.

If you do not upload your transcript with this registration, please bring a hard copy with you to your first meeting.

Current GPA

CollegeBoard (SAT)

Username	Password

ACT

Username	Password

Naviance

Username	Password

Common Application

Username	Password

Parent/Guardian 1 Information

Parent 1 Name*

First Middle Last Suffix

Parent 1 Email*

Enter Email Confirm Email

Parent 1 Address (if different from Student)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent 1 Cell Phone*

Parent 1 High School

Parent 1 Undergraduate Education

College	Degree(s) Earned

Parent 1 Graduate Education

Graduate School	Degree(s) Earned

Parent 1 Occupation

Job Title	Employer

Referred by*

Name of Referral

First Last

Please specify*

Parent/Guardian 2 Information

Parent/Guardian 2

Yes
No

Parent 2 Name

First Middle Last Suffix

Parent 2 Email

Enter Email Confirm Email

Parent 2 Address (if different from Student)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent 2 Cell Phone

Parent 2 High School

Parent 2 Undergraduate Education

College	Degree(s) Earned

Parent 2 Graduate Education

Graduate School	Degree(s) Earned

Parent 2 Occupation

Job Title	Employer

Sibling Information

Sibling(s)

Yes
No

Sibling Information

Name	Age	School

Service Options

#1: Comprehensive Package - College Search Service for juniors and seniors	$3,500
#2: Comprehensive Package - College Application Service for seniors	$3,500
#3: Starter Package - College Planning Service for sophomores	$1,500
#4: Starter Package - College Introduction Service for freshmen	$1,000
#5: Single-Service Option - Career Counseling Session	$800
#6: Single-Service Option - College List Review Service	$800
#7: Single-Service Option - College Essay Service	$1,000
#8: Single-Service Option - College Application Review Service	$800
#9: Single-Service Option - Academic Success Coaching (4-hour block)	$1,000
#10: Single-Service Option - Career Success Coaching (4-hour block)	$1,000

NOTE: Payment Plans available for Comprehensive Packages only (Service Options 1 and 2)

Payment Details

Select Payment Method*

Pay in Full (check)
Pay in Full (credit card)
Pay in Installments (credit card only)

Service

Select Service Option(s):

Deposit (for Comprehensive Packages only)

#1: College Search Service - Deposit
#2: College Application Service - Deposit

Total

$0.00

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Please make check payable in full to "One-on-One College Consulting" and mail to:

One-on-One College Consulting, LLC
Lakeside Office Park
607 North Avenue, Door #14, 2nd Floor
Wakefield, MA 01880

NOTE: Appointment(s) will not be scheduled until payment is received.

College Application Service - Future Intention

If you are not registering for the College Application Service at this time, would you like to reserve a spot? Please note that we limit the number of students we work with each fall. By reserving a spot now, we can get a head start on your student's application meetings. Your account will reflect future payment plan installments for the College Application Service.

Reserve a Spot?*

Yes
No
Not Sure

Parent/Guardian Signature

I confirm that all information provided on this registration form is accurate. I authorize One-on-One College Consulting to charge my credit card for future payment plan installments (if applicable).

Parent/Guardian Electronic Signature*

Next Steps

Once you click on the submit button below, and we have received your payment, you can expect a 'Welcome' email with instructions on getting started with One-on-One College Consulting.

Thank you!

Email

This field is for validation purposes and should be left unchanged.

One-on-One College Consulting

Registration & Payment – College Services

Student Information

Parent/Guardian 1 Information

Parent/Guardian 2 Information

Sibling Information

Service Options

Payment Details

College Application Service - Future Intention

Parent/Guardian Signature

Next Steps

IECA Associate Member

Nationally available via Zoom

MBTI® Certified Practitioner