Multnomah Education Service District-TS
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  • Alternative Pathways Application

    Please complete this form so that we may have enough information to provide you with services and activities.

  • Si desea ver el formulario en español, cambie el idioma en la esquina superior derecha.

    • Student Information 
    • Date of Birth*
       - -
    • Gender*
    • Ethnic Background*
    • The Student is: (check all that apply)*

    • ** If any of the above are true, parents information is not necessary and the student must provide their own income information.

    • Citizen Information

       

    • Are you a citizen of the United States?*
    • Are you a Resident Alien (RA)*
    • Are you in the process?*
    • Do you speak a native language other than English?*
    • Parent/Guardian Information 

    • The following information is required by the federal government to ensure we are providing services with guidelines and to determine the economic eligibility of each applicant. Failure to complete this section could result in delay or denial of student's admission to Alternative Pathways.  All information is confidential in compliance with the Federal Family Rights and Privacy Act and will be kept on file at the Alternative Pathways TRiO Talent Search office located at the Multnomah ESD administrative office.

    • Parents Education Level

    • Do either of the student's natural or adoptive parents have a 4-year college bachelors degree?*

    • Household Income

    • Total number of family members living at home*
    • What was your taxable family income last year?*
    • Media Release 
    • Select one*
    • Field Trip Release 

    • Several times per year, Alternative Pathways offers field trips to local colleges, universities and technical or training institutions. Alternative Pathways covers the transportation costs associated with these field trips as well as coordinates all activities and supervises students. *In order for your student to participate in a field trip sponsored by Alternative Pathways, the following field trip permission slip must be signed.

      I authorize this student to participate in Alternative Pathways field trips. I understand in signing this form, I am releasing Multnomah Education Service District and Alternative Pathways, the director and employees thereof from all claims and demands for any harm, injury or damage which my befall my child during any field trip.

      I understand and agree that neither Multnomah Education Service District and Alternative Pathways, the director and employees thereof may be held liable for any occurrence in connection with any field trip which may result in injury or damages to my child.

      I understand that my students are expected to represent themselves and the school when participating on field trips. If any rules or responsibilities are violated, my child will not be permitted on any future Alternative Pathways trips for the duration of the school year.

    • To the best of my knowledge, all the information I have provided in this application is true.

      I hereby authorize Alternative Pathways, TRiO Talent Search program to contact and request information from, as well as share information with the student's school, teachers, counselors and postsecondary admissions offices. I give my student, (if under 24 years of age), permission to participate in Alternative Pathways activities if accepted. Our signatures below indicate our commitment to the Alternative Pathways program. By signing the following statement you agree that you are not receiving services from any other TRiO project.

    • Clear
    • Date Signed*
       - -
    • Clear
    • Date Signed
       - -
    • ALTERNATIVE PATHWAYS STUDENT INFORMATION 
    • School*
    • Please indicate grade level:*

    • Do you qualify/receive*

    • To the Student: Please complete section which corresponds to your current grade level so that we can get a better idea of the assistance you need.

    • Senior Year/GED Students

    • Select the skills you would like help with and the activities you would like to participate in

    • Junior Year

    • Select the skills you would like help with and the activities you would like to participate in

    • Freshman/Sophomore Year

    • Select the skills you would like help with and the activities you would like to participate in
    • Submit  
    • Should be Empty: