Start intake — Unique Prep

About you

Who are we talking with, and how do we reach you?

Who is filling this out?

Parent or guardian Student

Parent or guardian name (required)

Please enter a name.

Relationship to student

Email (required)

Please enter a valid email address.

Cell phone (required)

Please enter a phone number.

Second parent or household, if we should contact them too (optional)

How did you hear about us?

Who referred you? (optional)

Where are you located?

The student

Who are we working with?

First name (required)

Please enter the student's first name.

Last name (if different from yours)

Student email (optional)

Student phone (optional)

School

Current grade

Does the student drive?

Yes No

Siblings (optional — ages, or where they went to college)

Testing accommodations (optional) If the student is approved for extended time on the ACT or SAT, we administer practice tests under matching conditions.

None 50% extended time 100% extended time Application pending Not sure

Score history

Any official or school-administered scores so far. Skip this entirely if there are none yet — that is completely normal.

Which test are you interested in preparing for? ACT SAT Not sure — help us decide PSAT / National Merit

Target schools or score goals (optional)

Previous preparation

Has the student done any test prep before?

Any previous prep?

No, this is the first Yes

School and schedule

Course load and activities tell us how much room there actually is in the week.

Approximate GPA, or typical grades (optional)

Current or upcoming courses (optional) Mark AP or Honors where they apply.

Anything else about school (optional)

Sports, activities, clubs, jobs (optional)

General availability for sessions Tap any blocks that usually work. This is just a starting point — we will settle on a real time when we talk.

Time	Sun	Mon	Tue	Wed	Thu	Fri	Sat

Notes on schedule (optional)

The student, in your words

This is the part that is hardest to get from a score report, and the most useful for planning. Say as much or as little as you like.

How does this student work? (optional) Work ethic, attention span, confidence with timed tests, how they take direction, anything about how they learn best, and any diagnosed learning differences you would like us to know about.

College thinking so far (optional)

Are you working with an independent college counselor? (optional)

We read every form personally and reply within two business days. Nothing here is shared with anyone outside Unique Prep.

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