University Of Central Florida-BEST-SSS-Application Form

Name*

First NameMILast Name

Email:*

example@ucf.edu

Phone Number:*

(999)999-9999

Student ID [7-digit number]:*

Date of Birth:

mm-dd-yyyy

Gender:

MaleFemaleOther/No Response

Ethnicity

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Eligibility (Check all that apply):

1st Gen: Both parents without bachelor degreesLow-Income: Complete IVF Form BelowDisability: Registered w/ Student Accessibility Services

US Citizen?

YesNo

(If applicable) US Permanent Resident ID#

Major:

Current GPA:

1st Enrollment Date at UCF:

Current Class Level:

Entry Year at UCF

Choose your pathway:

The Project BEST Pathways are specifically designed for students to develop leadership skills (Ambassadors), prep for grad school (Grad Gurus), or cultivate entrepreneurial skills (Enterprisers) to explore academic or professional goals.

I confirm that I have verified the above information and this application.

Student Signature

Project BEST is a TRIO Student Support Services (SSS) federal program funded by a grant from the U.S. Department of Education. The SSS grant provides opportunities for academic development, assists students with basic college requirements, and serves to motivate students toward the successful completion of their postsecondary education. The goal of the SSS grant is to increase the college retention and graduation rates of its participants.

TRIO SSS Programs serve college students who are first-generation, demonstrate a high financial need as defined by the Federal TRIO Programs Current-Year Low-Income Levels, and/or have a documented disability. Two thirds of SSS scholars must be both first-generation and lowincome. Each semester all SSS scholars are required to meet with their SSS advisor, attend two workshops, and engage in at least two services.

Please read the following statement carefully:

I give permission to Project BEST to access my student records. I understand that if I am disqualified from the University of Central Florida, this will impact my eligibility to continue in the Project BEST program. Either the Program Manager or I may void this contract without any obligations.

I understand to continue to be apart of the Project BEST program, and receive a graduation cord and/or stole I must agree to and fulfill the following requirements:

I agree to meet with the Project BEST Manager, Academic Support Coordinator AND/OR Academic Coach at least once per semester and will need to complete an Individualized Academic Plan (IAP).
I agree to complete any assigned activity within my pathway each academic cohort year (Fall, Spring and Summer).
I agree to attend a minimum of two (2) hours of tutoring each semester with a Project BEST Academic Coach, SARC, SI, the Writing Center, or the Math Lab.
I agree to meet with each of my professors at least once (1) each semester.
I am aware that federal regulations require Student Support Services track my academic records until I graduate

Student Initial:

Educational Goal:

Describe your career and/or professional goals and possible challenges you face.

The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education. Additionally, The Privacy Act of 1974, Title 5 U.S.C. § 552a, establishes a code of fair information practice that governs the collection, maintenance, use, and dissemination of personally identifiable information about individuals that is maintained in systems of records by federal agencies.

I. Documentation, I hereby give permission for the Student Support Services Program to retrieve, store, and report the following information: College Grade Reports and Transcripts (official and unofficial), SAT/ACT Scores, Financial Aid Award Notices, and, if applicable, documentation regarding status as a Learning Disabled (LD) or Physically Impaired person, or any other information regarding my status as a University of Central Florida student.

II. Tracking, I hereby give permission for the Student Support Services Program to retrieve, store, and report education verification information and student outcomes research about me that is gained from the National Student Clearinghouse and other sources.

III. Images, I give Student Support Services permission to photograph, video tape and/or record me. Further, I give permission for the Student Support Services Program to use and store these images on Web sites, brochures and/or program and media related publications.

IV. Sharing, I hereby give permission for the Student Support Services Program to share my UCF email, phone number, permanent address, class schedule and learning style with TRIO Programs student staff (peer mentors, peer tutors, and academic coaches) to use in student-to-studentsessions.

I understand that the information contained herein will be kept in confidence and will not be revealed to anyone except Student Support Services personnel, University of Central Florida officials such as the Registrar’s Office, Student
Disability Services, Office of Financial Assistance or representatives of the United States Department of Education and in accordance with the Family Educational Rights and Privacy Act.

Full Name

First NameLast Name

Student Signature

Date

mm-dd-yyyy

Household Income

The following information is utilized in determining your eligibility for this program and will remain confidential. Failure to accurately answer a question(s) may result in denial of your application.

Please complete Sections A and B.

SectionA : Answers questions about yourself(as appropriate):

Tax Return Status:

1. I or my parent/guardian filed a 2023 tax return.2. I did not file a 2023 tax return

a. What is the total number of people (including you) in your household?

b. What was your taxable (not total) income in 2023? $

Your taxable income can be found on your federal tax return.

On IRS Form 1040 (2023), see line 15

Please select:

3. I receive federal work study.4. I receive the federal Pell Grant.5. I receive SNAP benefits.6. I receive Public Assistance.7. I receive Vocational Rehab Services.

Section B: Please read the following statement and then sign and date.

By signing this 2024-2025 Income Verification Form, I am verifying that the information that I have provided to the UCF TRIO Student Support Services program is true and correct.

Student’s Name

First NameLast Name

Student’s Signature

Date

mm-dd-yyyy

UCF Project BEST Application

Confidentiality and Release of Information

Income Verification Form