University Of Arkansas-Hope-Texarkana-SSS

Consent Statement
I hereby consent to the release of my academic and financial aid record/information to the TRiO Student Support Services Program. I hereby certify that all information contained herein is accurate. I give permission to the TRiO SSS Program to secure my academic/financial information from appropriate UAHT sources in order to provide the services that I am requesting.*

YesNo
Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy

Participant Agreement Contract
I accept this opportunity to participate in the University of Arkansas Community College at Hope-Texarkana TRiO Student Support Services Program. I understand the goals of this program are to retain and graduate eligible U of A at Hope/Texarkana students. I further understand that selection as a participant of the TRiO Student Support Services Program is a privilege.

I understand and agree to the following terms of the U of A at Hope/Texarkana TRiO Student Support Services Program. Please read and initial each statement below.
I will utilize TRiO SSS Services. *
(initials)
I will meet with my Educational Specialist at least three times each semester.*
(initials)
I will complete the Financial Literacy requirements.*
(initials)
I do hereby agree to the conditions stated in this PARTICIPANT AGREEMENT CONTRACT.*
(initials)
Authorize usage of photographs *
(initials)

Personal Education Plan
Name*

First NameLast Name
MY DEGREE/CERTIFICATE OBJECTIVE: (See UAHT catalog DEGREE AND
CERTIFICATES pages 85 - 87)
Short Term Goal:*

Associate of Arts DegreeAssociate of Applied Science DegreeAssociate of Science DegreeTechnical CertificateCertificate of ProficiencyUndecided
Major*
Long Term Goal:*

Bachelor's DegreeMaster's DegreeSpecialist DegreeDoctoral Degree (PhD)
Briefly describe your career goals. (What do you want to be)*
Serviceses Requested: (Check all that apply)
Academic Support*

TutoringComputer Lab
Academic Information*

Study SkillsTest AnxietyTime Management
Transfer Support
Do you plan to transfer to a 4 year college?*

YesNo
Campus/Transfer Visitation*

HSUOBUSAUTAMUTUALROther
Social/Cultural Support*

TRiO Student Success ClubCultural Awareness (Activities, Events, and Trips)Social InformationStress ManagementSocial Issues Effecting College Success
PLEASSE COMPLETE ASSESSMENT BELOW

NEEDS ASSESSMENT
Please check each area where you will need assistance:*

Test AnxietyTime ManagementBudget/Money ManagementScholarship SearchDegree Plan and Course SelectionMath Skills
PARTICIPANT AGREEMENT CONTRACT

I accept this opportunity to participate in the University of Arkansas Community College at Hope-Texarkana TRiO Student Support Services Program. I understand the goals of this program are to retain and graduate eligible U of A at Hope/Texarkana students. I further understand that selection as a participant of the TRiO Student Support Services Program is a privilege.

I understand and agree to the following terms of the U of A at Hope/Texarkana TRiO Student Support Services Program. Please read and initial each statement below.*

	Initial Here
I will utilize TRiO SSS Services.
I will meet with my Educational Specialist at least three times each semester.
I will complete the Financial Literacy requirements.
I do hereby agree to the conditions stated in this PARTICIPANT AGREEMENT CONTRACT.
Authorize usage of photographs

Participant's (Printed) Name*

First NameLast Name
Participant's Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy