University Of Maine-Augusta-SSS-2024 Application Form

TRIO Application/Intake
Name

First NameMiddle NameLast Name
Student ID No.
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone No:
(999)999-9999
Email
example@example.com
Birth date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender
Campus/Site Location
Are you a U.S. Citizen or Permanent Resident?
Select one or more races
Last high school grade and year completed:
Year:
In which 4-year degree program are you currently enrolled at UMA? (2-year degree program students are not eligible for TRIO services?
Are you a transfer student
Last attended college (date)
Do you hold a completed bachelor’s degree from any institution?
- Please check all items that apply to you about your financial independence
- Please indicate which of the following best describes your family
- Do you have a disability that could interfere with your learning? Disability can include learning, speech, behavioral, emotional, physical, mobility, developmental, and/or sensory disabilities.
- What is the highest level of education your biological or adoptive mother has completed?
- What is the highest level of education your biological or adoptive father has completed?
- Academic need - please check all that apply to you
- Please read the following descriptions of services offered in the TRIO Scholars Program. Please indicate if you would like to participate in any of these service
- Have you ever participated in any of the following State or Federal student support programs?
- State one academic goal you have set for yourself this year:
- What is your ultimate career goal?
- List at least one academic strength and one personal strength you possess:
- List any academic, personal, financial, or career planning concerns you have for this year:
- Have you completed your FAFSA for this year?
- Have you completed your FAFSA for next year?
- Do you have a work study job?
- Do you work off campus?
- (if yes, how many hours/week)
- Do you have outside commitments, e.g., volunteering, family, caregiving, etc. that might interfere with your class work?
- Do you have any challenges like funding, transportation, or childcare that might interfere with your class work?
- How do you think the TRIO Program can help you?
- Is there anything else you would like to tell us?
- By signing below, I confirm all information provided on this form is accurate according to my knowledge. I understand that as a TRIO Scholars, my grades will be periodically reviewed by UMA TRIO staff (to include trained and authorized Peer Coaches). I give permission for TRIO staff to monitor my progress in the areas of financial aid, economic literacy, course selection, tutoring, academic progress, graduate school advising, and student engagement. Monitoring my progress may include TRIO staff contacting my advisor(s), faculty members, or other staff invested in my academic success at UMA. By submitting this application, I also grant TRIO Scholars Program staff permission to contact the UMA Financial Aid Office about my eligibility for program services and scholarship
- Student signature
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Consent to Use Name and Photo
  If I win a drawing or participate in activities, I give UMA TRIO Scholars permission to publish my name and/or photographs of me in newsletters, on the website, and on official social media accounts for promotional and informational purposes.
- I understand this consent is voluntary, and I may withdraw it at any time by contacting Lena Michaud, Associate Director, at lmichaud@maine.edu.
- Name
  
  First NameLast Name
- Signature
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Consent Statement: (Section 8 of 8)
  
  If I win a drawing or participate in activities, I give UMA TRIO Scholars permission to publish my name and/or photographs of me in newsletters, on the website, and on official social media accounts for promotional and informational purposes.
- I understand this consent is voluntary, and I may withdraw it at any time by contacting Lena Michaud, Associate Director, at lmichaud@maine.edu.

TRIO Application/Intake