Client Contract Form

Date:
Phone:
Student's Full Name:
Student's E-mail:
Current Grade:
High School:
Parent 1:
Parent 2:
Parent's E-mail:
Street Address of Student:
City:
State:
Zip:
Home Phone (Parents):
Student Cell Phone:
Fax #:
E-mail Student:
E-mail Parent 1:
E-mail Parent 2:
May we email you in a group email?
How were you referred to our service?

Does your student have any learning differences, physical handicaps, or emotional issues we should be aware of? If so, please call to discuss: 310-713-8765 or list below. All comments are confidential.

List

Please Read and Sign:

The undersigned hereby contracts services from Susanne Condon (AKA Coast 2 Coast College Counseling), in accordance with the conditions and fees set forth below for the academic year of 2018-2019 (ending 6/30).


Check Grade Level Consultation that Applies

Date of Consultation:

Date of Consultation:

Date of Consultation:

Date of Consultation:

Date of Consultation:

Date of Consultation:

Focused application/essay work, extensive summer internship and job research, athletes, musicians, actors, students with special needs or learning disabilities and essay review for scholarship applications may require additional fees.
I understand that Wendy Gilbertson and Susanne Condon (AKA: Coast 2 Coast College Admissions) will use their best efforts to assist and direct my student in the college planning/application process.
I understand that Wendy Gilbertson and Susanne Condon will edit, but not write my student's essay(s). I understand that my student is solely responsible for meeting his/her application deadlines.
I understand that Wendy Gilbertson and Susanne Condon may express an opinion concerning the likelihood of admission, but they do not guarantee the student's admission to any particular college or
university, as admission decisions are made solely by the university.
Fees due and payable to Coast 2 Coast College Admissions at time of consultation. After 60 days, a late fee of 1% per month will be charged.
The undersigned hereby contracts services from Wendy Gilbertson and Susanne Condon (AKA Coast 2 Coast College Admissions), in accordance with the conditions and fees set forth below for the academic year of 2014-2015 (ending 6/5).