Gateway Community & Technical College-SSS-Application Form

TRIO Project ASPIRE

Gateway Community and Technical College

Program Application 2024-2025

Legal Name:*

First NameLast Name

Preferred Name:

Date of Birth:*

mm-dd-yyyy

Gender:*

Ethnicity:*

Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

KCTCS/Gateway Student ID#:*

KCTCS/Gateway Email Address:*

example@example.com

Personal Email Address:

example@example.com

Cell phone:*

(999)999-9999

Gateway TRIO Project ASPIRE may send SMS text messages to provide information and services related to the program. You can expect monthly messages about important deadlines, upcoming events, and appointment reminders. Do you agree to receive text messages from us?*

Yes, I agree to receive text reminders from TRIO Project ASPIRENo, I do not agree to receive text reminders from TRIO Project ASPIRE

Home Phone:

(999)999-9999

High School Graduate Year? *

{year)

GED Year?

(year)

Degree Plan: Major*

Degree Plan:*

Associate degreeCertificate only

Do you intend to transfer to a four-year institution*

YesNo

Are you Registered in the Gateway2NKU transfer program?*

YesNo

Are you participating in the River City Promise Program?*

YesNo

Are you Pell Grant eligible?*

YesNo

Do either of your parents/guardians have a bachelor's degree?*

YesNo

Are you a U.S. Citizen?*

YesNoPermanent Resident

If No, are you eligible for federal financial aid?*

Permanent Resident?*

Do you have a federally recognized disability?

YesNo

Are you registered with Gateway's Office of Accessibility Services?

YesNo

Signature

Date

mm-dd-yyyy

TRIO Project ASPIRE

Gateway Community and Technical College

Income Verification 2024-2025

(Provide information as you submitted it to FAFSA for 2024-2025 Academic Year)

Based on your answers to the FAFSA Dependency Determination questions above are you:*

Independent (your income only)Dependent (parents' income from FAFSA required)

Use information from your 2022 Federal Income Tax Return in this section:

How many people live in your household? (include yourself and children away at school)*

What was the taxable income on your 2022 Federal Income Tax Return? (As listed on your FAFSA) See line 15 on IRS tax form 1040.*

By signing below, I certify that the information provided in this section is accurate and taken from my 2022 Federal Income Tax Return? I understand that failure to complete and sign this section will result in our inability to process this application for participation in TRIO Project ASPIRE.

Signature*

Date*

mm-dd-yyyy

(Independent status requires student signature only)

Parent Signature*

Date*

mm-dd-yyyy

TRIO Project ASPIRE

Gateway Community and Technical College

Individual Needs Assessment 2024-2025

Student Name:*

First NameLast Name

KCTCS/Gateway Student ID#:*

Please take the time to identify ways in which the TRIO-Project ASPIRE project can support you in your academic career here at Gateway Community & Technical College. Check all that apply .

Academics:*

Unsure high school prepared me for collegeEarned a GEDConcerned about my math and/or writing skillsUnaware of my learning styleInexperienced with study strategies that work for meDo not meet the minimum requirements for desired majorIt's been more than 5 (five) years since I have been enrolled in any schoolWould benefit from tutoring to be successful in coursework

Major/Career:*

Uncertain about my future careerDon't know which majors would be a good fit for meHave many interests but can't seem to pick one majorDecided on a major but not sure I have the preparation to succeed in itInexperienced in selecting appropriate courses that would lead to graduationHave a clear understanding of whether my desired major would lead to a need to transfer beyond an associate degreeNone of these

Personal:*

Plan to work over 20 hours a week and go to school full timeA parent of children under the age of 19 in your homeSignificant family responsibilities (children, siblings, parents)Entering college as a non-traditional age student (25 or over)Undecided about whether college is for meEnglish is a secondary language for meNeed help managing significant financial responsibilities

Signature:*

Date:*

mm-dd-yyyy

TRIO Project ASPIRE

Gateway Community and Technical College

Program Participation Agreement 2024-2025

TRIO Project ASPIRE Participation Contract

If accepted into TRIO Project ASPIRE services, I will be eligible for the following benefits:

Dedicated TRIO advisor who serves as my Academic, Career, and Resources consultant
Individualized Success Plan to guide my college experience
Financial Aid counseling
Degree Audits
Transfer counseling
Monthly Success Workshops
Tutoring resources
Dedicated computer lab with free printing

If accepted into TRIO Project ASPIRE services, I will agree to the following:

Complete an Individual Success Plan (ISP) within the first 4 (four) weeks of the fall term
Meet with my TRIO Advisor at least 2 times per semester
Committed to working with my TRIO Advisor in developing plans to support my academic success.
- First year Plan with Goal Setting
- Majors plan
- Career plan
- Graduation plan
- Transfer plan
Complete Financial Aid Audit each fall
Submit my FAFSA by Oct 1 for priority consideration for all state and federal aid
Submit the KCTCS/Gateway scholarship application each March
Review my midterm grades each semester and discuss my progress with my TRIO advisor
Read email communications from TRIO to stay up to date of program activities, resources and deadlines
Complete any recommended/required online modules
Be honest and conscientious with my TRIO Advisor and use the TRIO services to assist me in being a successful college student

To fulfill these responsibilities, I will:

Notify program staff if I cannot attend a scheduled appointment, event or workshop . I will make this contact at least 24 hours before the scheduled time.
Communicate any concerns with classes or financial aid as soon as possible for the greatest chance for success
Complete classroom assignments on time and adhere to the institutions code of conduct
and honesty around plagiarism and the use of Al in classroom assignments

Signature*

Date:*

mm-dd-yyyy

TRIO Project ASPIRE

Gateway Community and Technical College Program

Consent to Release 2024-2025

I understand that TRIO Project ASPIRE needs to access to my financial, personal, academic, and disability related information in order to provide the best possible support for me at Gateway Community and Technical College. Therefore, I agree to release such information to the TRIO staff members as long as I am considered an active TRIO participant or a Gateway student. I further understand that all released information/material will remain confidential. I also agree to allow sharing of information with Community partners like the Scholar House.*

Yes, I agree to allow TRIO to share my informationNo, I do not agree to allow TRIO to share my information

I agree to allow my name and/or picture to be printed in any TRIO Project ASPIRE newsletters, website, publication, or display in recognition of academic success, involvement, leadership or graduation*

Yes, I agree for TRIO to use my name and/or pictures in the ways listed aboveNo, I do not agree for TRIO to use my name/picture in the ways listed above

Signature :*

Date:*

mm-dd-yyyy

Education Information:

Graduation Plan:

TRIO Eligibility Information: