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
Gender

MaleFemaleNonbinary or Other
Campus/Site Location
Are you a U.S. Citizen or Permanent Resident?

YesNo
Select one or more races

American Indian/Alaskan NativeAsianBlack/African AmericanHispanic/LatinoNative Hawaiian/Pacific IslanderWhite/Caucasian
Last high school grade and year completed:

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?
Are you a transfer student

YesNo
Last attended college (date)
Do you hold a completed bachelor’s degree from any institution?

YesNo

Individual Learning Plan:
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?

YesNo
Have you completed your FAFSA for next year?

YesNo
Do you have a work study job?

YesNo
Do you work off campus?

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

TRIO Application/Intake