Morehead State University-RPED-Non Trio-UB-Application Form

RPED-Rural Postsecondary & Economic Development Program Application
Attention Parents/Guardians & Students: To determine the eligibility for the RPED Program, this form must be completed by both the parent/guardian and student.

Thank you for your interest in the RPED-Rural Postsecondary & Economic Development Program at Morehead State University. Please complete the application below to express your interest in joining the program.

The RPED Program emphasizes skills needed for securing job placement in high demand, high wage fields and offers career counseling services for students. We also have opportunities to participate in internships, externships, pre-apprenticeships, registered apprenticeships, and/or mentorships.

The program is available to incoming and current Morehead State University students, as well as, 11th & 12th grade students in rural high schools in the following counties: Bath, Breathitt, Bourbon, Boyd, Carter, Clark, Elliott, Fleming, Floyd, Greenup, Johnson, Knott, Lawrence, Letcher, Lewis, Magoffin, Martin, Mason, Menifee, Montgomery, Morgan, Nicholas, Pike, Powell, Robertson, Rowan, Wolfe.

To determine eligibility students must meet at least one of the following criteria: be first generation or meet low-income guidelines set forth by the Federal TRIO Programs.

For Income Eligibility: You must provide your most recent tax returns (1040, 1040EZ, or 1040A) or tax transcript from the IRS. If your household had no taxable income, please submit an IRS Verification of Non-Filing Letter or a signed statement.

For 1st Generation Eligibility: The definition of first generation, used to determine eligibility for the federal TRIO programs and Pell Grant, is a student whose parent or parents did not earn a bachelor's degree, according to an amendment to the Higher Education Act of 1965.
For Income Eligibility: Most recent tax return (1040, 1040EZ, or 1040A) or tax transcript from the IRS.

For 1st Generation Eligibility: The definition of first generation, used to determine eligibility for the federal TRIO programs and Pell Grant, is a student whose parent or parents did not earn a bachelor's degree, according to an amendment to the Higher Education Act of 1965

The Release of Records is required for program participations. Records will be used to assess student needs, monitor progress, document eligibility, and for reporting purposes. This information is confidential and protected under the General Education Provision Act. Rural Postsecondary & Economic Development will not release any confidential information without your written consent.
- The Release of Records is required for program participations. Records will be used to assess student needs, monitor progress, document eligibility, and for reporting purposes. This information is confidential and protected under the General Education Provision Act. Rural Postsecondary & Economic Development will not release any confidential information without your written consent.
  
  I hereby grant permission for the Rural Postsecondary & Economic Development program at Morehead State University to have access to educational records of my child ___________________________________________ including, but not limited to the following:
  
  · Grades
  
  · test scores
  
  · free/reduced price lunch eligibility
  
  · class schedules
  
  · postsecondary enrollment
  
  · discipline records
  
  · attendance for the duration of the student's enrollment in the Rural Postsecondary & Economic Development program
  
  This also authorizes the postsecondary institutions to release to the MSU Rural Postsecondary & Economic Development program copies of college academic enrollment and student aid award information.
- Student Name (Print)
  
  First NameLast Name
- Email
  example@example.com
- Student Birthdate
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Parent/Guardian (if under 18yrs of age) or Student (if 18 years of age+) Name
  
  First NameLast Name
- Parent/Guardian Signature (if under 18yrs of age) or Student Signature (if 18 years or age +)
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Photos and videos are a great way to remember significant moments in life and celebrate student accomplishments. With your permission, the staff of the RPED program would love to take photos and videos of students for these purposes. Pictures and videos may be used for various print or media outlets including program promotions, newsletters, news articles, and official social media of the R.I.S.E Program or Morehead State University.
  
  By signing below, you grant Rural Postsecondary & Economic Development the right and unrestricted permission to use the students name, image, and voice in any photos, video recording, audiotapes, digital images, and the like, take or made on behalf of Rural Postsecondary & Economic Development or its partners.
  
  By signing below, you agree that Rural Postsecondary & Economic Development Program has complete ownership of such material and can use said material for any purpose consistent with the Rural Postsecondary & Economic Development missions. These uses include, but are not limited to, photographs, videos, publications, advertisements, new releases, websites, social media, and any promotional or educational materials in any medium.
  
  By signing below, you acknowledge that you or whom you are signing on behalf of will not receive any compensation for the use of such images, videos, likeness, etc.
- High School:
- Grade Level
- Student Name (Print):
- Parent/Guardian Name (if under 18yrs of age) or Student Name (if 18 years of age+)
- Parent/Guardian Signature (if under 18yrs of age) or Student Signature (if 18 years of age+)
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Name:
  
  First NameLast Name
- Student Date of Birth:
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Gender:
- Social security number:
  999-99-9999
- Address:
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Parent/guardian phone number:
  (999)999-9999
- Parent/guardian email:
  example@example.com
- Student phone number:
  (999)999-9999
- Student email:
  example@example.com
- Emergency contact name:
  
  First NameLast Name
- Emergency contact number:
  (999)999-9999
- Student shirt size:
- Which school do you currently attend?
- Are you currently involved with any of the following dual credit options?
- Current Grade
- Current GPA
- Will you be a first generation college student (neither parent/guardian completed a four year degree)?
- What do you plan to do after you graduate from High School?
- What is your area of interest in the following degree fields:
  
  Other Degree Programs Not Listed:
- Who does the student live with MOST of the time?
  
  Other
- Parent/Guardian Employer
- What is the HIGHEST level of education obtained by either biological or adopted. (Who the student livers with)
  
  Other
- Done anyone in the household qualify for the following:
- Where you involved with the foster care system or considered a ward of the state between the ages of 13 - 18?
- What is the total number of people in the household, including participant
- What was your household's taxable income last year (The R.I.S.E program will operate based on the same federally approved income guidelines as the TRIO programs.)
- For Income Eligibility: You must provide your most recent tax returns (1040, 1040EZ, or 1040A) or tax transcript from the IRS. If your household had no taxable income, please submit an IRS Verification of Non-Filing Letter or a signed statement.
  
  Cancelof

RPED-Rural Postsecondary & Economic Development Program Application