University Of Nebraska-Omaha-SSS-2023 Application Form 2

Written Questions
Why do you want to participate in Project Achieve? Why and how can Project Achieve help you?*
Tell us about a time you were able to achieve a goal. What was the goal? What helped you achieve your goals?*
Tell us about a time you were not able to achieve your goal. What was the goal? What prevented you from achieving your goal?*

Acknowledgements and Signature
I understand that Project Achieve staff can assist me in achieving my goals only if I fulfill my obligation to take advantage of the serves provided and that failure to meet my responsibilities can result in a suspension or termination from the program.*

I Understand
I hereby attest that the information provided is true to the best of my knowledge, and I authorize Project Achieve to verify the information I have provided on my application and to access information related to my attendance, academic performance, graduation as well as other information necessary for the proper delivery of the program services. I also understand that the information in my Project Achieve file may be viewed by other agencies to which the Project Achieve program is accountable. I authorize Project Achieve to include information about and images of me in Project Achieve marketing materials.*

I agree
Signature:*

Clear
Date*

MonthDayYear
Date

PROJECT ACHIEVE APPLICATION