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
Date
MaleFemale
Campus/Site Location
YesNo
American Indian/Alaskan NativeAsianBlack/African AmericanHispanic/LatinoNative Hawaiian/Pacific IslanderWhite/Caucasian
9101112GED or HiSET
Year:
In which 4-year degree program are you currently enrolled at UMA? (2-year degree program students are not eligible for TRIO services?
YesNo
Last attended college (date)
YesNo
- I am 24 years old or olderI am married I am a veteran or on active duty in the U.S. armed forcesI have legal dependents who receive more than half of their support from meI was in foster care or a ward of the court since the age of 13I was an emancipated minorI was an unaccompanied homeless youthNone of these apply to me
- 1 family unit member and adjusted gross income (AGI) equal to or less than $23,9402 family unit members and adjusted gross income (AGI) equal to or less than $32,4603 family unit members and adjusted gross income (AGI) equal to or less than $40,9804 family unit members and adjusted gross income (AGI) equal to or less than $49,5005 family unit members and adjusted gross income (AGI) equal to or less than $58,0206 family unit members and adjusted gross income (AGI) equal to or less than $66,5407 family unit members and adjusted gross income (AGI) equal to or less than $75,0608 family unit members and adjusted gross income (AGI) equal to or less than $83,580I have more than 8 members in my family unitI am not a low-income student
- Yes, I have a disability documented with UMA's Center for Student Support & Development.No, I do not have a documented disability.I need more information about documenting my disability with UMA's Center for Student Support Development
- Less than high school completionHigh schoolSome college or 2-year degree4-year degreeGraduate schoolNot applicable
- Less than high school completionHigh schoolSome college or 2-year degreeBachelor degreeGraduate schoolNot Applicable
- I had low grades in high schoolI had low Accuplacer scoresI had low SAT or ACT scoresI had a low score in another academic proficiency testI have had low grades in college coursesI have a GED™, HiSET™, or TASC™ credentialI have experienced failing gradesI have been out of school for 5 or more yearsOther academic needsI have Limited English Proficiency (LEP)I don't know what my educational or career goals areI feel unprepared for college-level course workI need help bringing up my grades in required courses for my major
- Amplified academic tutoringAdvice and assistance in post-secondary course selectionEducation/coaching to improve financial and economic literacyInformation about applying for Federal Student AidAssistance in completing and applying for Federal Student AidAssisting in applying for admission to Graduate School and obtaining Federal student aidSupport in navigating your university experiencePersonal coachingCOL 123 Learning & The College Community A tuition reimbursed 3-credit course, if eligibleSSC 317 Leadership Seminar A tuition reimbursed 3-credit course, if eligibleAccess to annual grant aid funding if eligible
- TRIO Student Support Services at UMATRIO Student Support Services at another institutionTalent SearchUpward BoundUpward Bound Math-ScienceVeterans' Upward BoundEducational Opportunity CenterGEAR UPJobs for Maine Graduates (JMG)None of these apply
- 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:
- YesNo
- YesNo
- YesNo
- YesNo
- (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
  
  Clear
- Date
  
  MonthDayYear
  Date
- 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.
- Yes, I consentNo, I do not consent
- Name
  
  First NameLast Name
- Signature
  
  Clear
- Date
  
  MonthDayYear
  Date
- 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.
- Yes, I consentNo, I do not consent

TRIO Application/Intake