University Of Pikeville-SSS

  • Application for Services

    Please complete this eligibility form.

    Students interested in becoming a member of the ACE Program must meet the eligibility requirements as set forth by the U.S. Department of Education for TRiO programs. All student information is confidential.

    The University of Pikeville ACE Program will respond to let you know if you are eligible.

    • Student Information  

    • STUDENT INFORMATION SECTION: (TO BE COMPLETED BY STUDENT)

    • Date of Birth
       - -
    • Gender
    • T-shirt Size
    • College Classification
    • Have you previously participated in one of the following TRiO programs?
    • Before age 18, with whom did you primarily live and receive financial or personal support from? (This information helps us determine eligibility and connect students with support resources.)

    • Select the highest level of education completed by your parents/legal guardians.

    • Father:

    • Mother:

    • Were you referred for services?
    • Do you have a documented disability?
    • Are you (or will you) receiving services through the Disability Resource Center (DRC)
    • Have you declared a major?
    • Would you like to receive more information on how you can attend the ACE JUMP START program that occurs the week prior to UPIKE first? This is a component of the ACE program that is designed to assist students in getting a jump start on meeting faculty and staff, making new friends, building a connection with peer mentors and completing the freshman service project early.
    • Release of Information 
    • I certify all the information provided in this application to be true and correct. I authorize the ACE Program (TRIO) to access the following information I have selected below to determine eligibility status in the program (eligibility may be affected without authorization):

    • I further authorize the ACE Program to release my name and/or picture to provide recognition in all Student Support Services and print and digital publications

    • Clear

    • (REQUIRED: applications cannot be processed without a signature)

    • RELEASE OF INFORMATION

      I certify all information provided in this application are to be true and correct. I authorize the ACE Program to access my University of Pikeville school records, including academic records, financial aid awards, FAFSA, and disability reports. I further authorize the ACE Program to release my name and/or picture to provide recognition in all Student Support Services print and digital publications.

    • Date Signed
       - -
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