Peer Coaching Intake

Peer Coaching Intake

Thank you for your interest in Peer Academic Coaching. Please complete this form so we can learn a little more about you, your experience at Northwestern University, and your goals for coaching. This information will be used to match you with a peer coach, but the peer coaches will not see this form, and you can designate information as confidential if you wish.

First and last name*

Pronouns (if you wish to share)

Northwestern University 7-digit ID number*

Northwestern email address*

Cell phone number*

Phone

What year are you in?*

School & major (if decided)*

Academic Adviser's Name

How did you hear about coaching?

Adviser

Website

Friend

Faculty member

Other

What brings you to coaching?

What specific topics would you like to discuss with a coach ? Choose all that apply.*

Time Management

Procrastination

Problem-Solving

Motivation

Study skills/exam preparation

Reading strategies

Effective note-taking

Managing large projects

Other

Availability

Please the check days/times when you are typically available to meet:

Monday

Morning (before noon CST)

Afternoon (12-5pm CST)

Evening (after 5pm CST)

Tuesday

Morning (before noon CST)

Afternoon (12-5pm CST)

Evening (after 5pm CST)

Wednesday

Morning (before noon CST)

Afternoon (12-5pm CST)

Evening (after 5pm CST)

Thursday

Morning (before noon CST)

Afternoon (12-5pm CST)

Evening (after 5pm CST)

Friday

Morning (before noon CST)

Afternoon (12-5pm CST)

Evening (after 5pm CST)

Saturday

Morning (before noon CST)

Afternoon (12-5pm CST)

Evening (after 5pm CST)

Sunday

Morning (before noon CST)

Afternoon (12-5pm CST)

Evening (after 5pm CST)

Additional Information

Is there anything else you'd like to share about your experience at Northwestern so far?

Is there anything you've written that you'd like ASLA to keep confidential and NOT share with a peer coach?

Thank you for completing our questionnaire. We will be in touch soon to match you with a peer coach.

Send me a copy of my responses

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