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Good News! We have begun taking applications from the Class of 2009 to work with a Bottom Line counselor. Please fill out the application below and press the submit button. If your interest and need matches our criteria then we will be in touch with you by phone or email to schedule an appointment. Please be advised that our counselor caseloads fill quickly and we will begin working with students in stages throughout the spring, summer and fall. Don't worry if we don't get back to you right away.


Contact Info

First Name:

Last Name:

Street Address:

Apt:

City:

State:

Zip Code:

E-Mail Address (required):

Re-enter E-Mail Address:

Cell Phone:

Home Phone:

Personal/Family Info

Gender:

Race/Ethnicity:

What is your US Citizenship Status?

Including yourself, how many people live in your home?

Does your family own or rent your home?

Who do you live with at home?

If you live with Mom, does she have a job?

If she has a job, what does she do for work?

How much money do you think your mother makes in a year?

If you live with Dad, does he have a job?

If he has a job, what does he do for work?

How much money do you think your father makes in a year?

How many cars does your family own?

If you had to guess, is your total family income above $40,000 or below?

Did either of your parents go to college?

Did either of your parents graduate from college?

Do any of your brothers and sisters go to college?

If yes, did any of them graduate?

Academic Info

High School:

Grade Level:

Are you taking any AP or Honors classes?

Please list your Freshman year grades

9th Grade English

9th Grade Math

9th Grade Science

9th Grade Social Studies

9th Grade Foreign Language

Please list your Sophomore year grades

10th Grade English

10th Grade Math

10th Grade Science

10th Grade Social Studies

10th Grade Foreign Language

Please list your Junior year grades (Estimate based on last report card)

11th Grade English

11th Grade Math

11th Grade Science

11th Grade Social Studies

11th Grade Foreign Language

Bottom Line Services

How did you hear about Bottom Line?

Please specify who told you about Bottom Line:

If you have any other comments or questions, please type them in the space provided below