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Certified Postage *

Senior Status *

IF YOU ARE A PREVIOUS STUDENT (A letter requesting the transcript must be submitted with your signature. The letter can be attached electronically with this request or sent to the Western Wayne Guidance Department, 1970A Easton Turnpike, Lake Ariel, PA 18436.)

Email Address *

Student Last Name *

Student First Name *

Telephone Number *

Please include area code, but no dashes.

Address *

Name of College - Scholarship *

Only ONE School or Institution per Request Form

Graduation Year *

Apply Online?

Online Application Date

If you applied online, what was the date of application?

Application Fee

Online Pay

Did you pay online?

Fee Waiver

SAT Date


ACT Date


Transcript Scores

Would you like the scores on the Transcript?


Are you attaching a resume?

Letter of Recommendation

Are you attaching letters of recommendation?

Counselor Form

Is there a Counselor Form?

Notes for Guidance