• Personal Information 
    • Date of Birth*
       - -
      2 digit month, 2 digit day, 4 digit year
    • Are you a US Citizen?*
    • Gender*
    • Are you now or have you ever been in foster care?*
    • Are you now or have you ever been homeless?*
    • Ethnicity: Mark all that apply.*
    • Eligibility 
    • Did your father graduate from a 4-year college?*
    • Did your mother graduate from a 4-year college?*
    • Would you like to apply for accommodations based on a disability?*
    • Did you receive a Pell Grant (Financial Aid)?*
    • What is your family's total taxable income? (Please Check One)*
    • 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.*
    • Date*
       - -
      2 digit month, 2 digit day, 4 digit year
    • 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.

    • Personal Education Plan 

    • MY DEGREE/CERTIFICATE OBJECTIVE: (See UAHT catalog DEGREE AND
      CERTIFICATES pages 85 - 87)

    • Short Term Goal:*
    • Long Term Goal:*

    • Serviceses Requested: (Check all that apply)

    • Academic Support*
    • Academic Information*

    • Transfer Support

    • Do you plan to transfer to a 4 year college?*
    • Campus/Transfer Visitation*

    • Social/Cultural Support*

    • PLEASSE COMPLETE ASSESSMENT BELOW

      NEEDS ASSESSMENT

    • Please check each area where you will need assistance:*

    • 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.*
      Rows
    • Date*
       - -
      2 digit month, 2 digit day, 4 digit year
    • Submit 
    • Should be Empty: