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Intake Form

Provide As Much Information As Possible

Provide As Much Information As Possible

Parent 1

Parent 2


Services requested (Check all that apply)
Services Requested (Check all that apply)

Payment for services rendered in no way acts as a guarantee of a specific outcome, no refund will be given for outcomes that fall short of a client’s expectations. As your coach, I will be honest and transparent when providing realistic expectations based on a student’s complete academic profile including extra-curricular activities and the selectivity or competitiveness of a given college or university. This agreement shall be governed by and subject to the laws and exclusive jurisdiction and venue of the Court of the Commonwealth of Virginia. Any lawsuit arising from this agreement shall be filed in the Circuit Court of Stafford County, Virginia. Or, if jurisdiction is appropriate, the United States District Court for the Eastern District of Virginia, Richmond Division, at the option of the Company. The Client waives all objections regarding the venue.

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