CLIENT CONTRACT FORM

Date:
Name of the Student:
High School:
Current grade in High School:
Student's Cell:
Student's E-mail:
Student's Home Address:
City:
State:
Parent 1-Name:
Parent 1-Cell Phone:
Parent 1-Email:
Parent 2-Name:
Parent 2-Cell Phone:
Parent 2-Email:
Home Phone:
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
Freshman/Middle School Consultation: $395.00
Date of Consultation:
Sophomore Consultation: $395.00
Date of Consultation:
Junior Consultation: $395.00
Date of Consultation:
Senior Consultation: $395.00
Date of Consultation:
Transfer Student Consultation: $395.00
Date of Consultation:
Follow Up Appointment (same year as consult) $150.00
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).

By checking this box and submitting this form you confirm that you
acknowledge and understand the above disclaimer.