SmartTrack Registration Form

All information provided in this form is considered confidential and will be used solely by SmartTrack College Success staff for the purpose of delivering academic support services. We do not share, sell, or disclose this information to any third parties without written consent, except as required by law.

(This registration form is for families who have already completed an initial consultation with SmartTrack. If you have not yet spoken with us, please schedule your consultation before completing this form.)

First Name (Student)

Last name (Student)

Email (Personal - Not School)

Phone Number

Student - Date of birth

Month

Day

Year

Current Grade/College Year

Current School Name

Declared Degree (Include Dual and Minors)

Parent Phone (Main Contact)

Parent Email (Main Contact)

Does the student currently receive accommodations through their college’s disability services office?

Have accommodations been approved for the upcoming semester?

Unofficial Transcripts (Required)

Disability Documentation (If Available)

Current Course(s) Syllabi

Other

As We Review Your Information and Prepare for the First Student Meeting, Is There Anything You’d Like to Add?