Fields in red are required.

Please provide the following contact information:

Name (First, Middle, and Last)
Title
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Preferred Phone Number
E-mail

Please identify and describe yourself:

Date of Birth	i.e. DD/MM/YYYY
Sex	Male Female
UM ID Number

 

Emergency Contact/person who will know your whereabouts in 5-10 years

Name                       Relationship    Phone Number

Other information

Race/Ethnicity	Select from list American Indian or Alaska Native Asian Black or African American Native Hawaiian or Pacific Islander White or Caucasian Hispanic or Latino More than one race No response
Veteran	Yes No
High School Graduate	Yes No
2010-2011 College Ranking:	Select from list First Time Freshman Freshman (less than 30 credits) Sophomore (31-60 credits) Junior (61-90 credits) Senior (over 90 credits)
Are you a transfer student?	Yes No

If you graduated from high school, please indicate the name of the high school and the year you graduated.  Freshmen only:  Please list your ACT composite score or SAT Composite in Critical Reading and Mathematics.  If you did not graduate from high school, leave this question blank.

If you completed your GED, state yes and what year. If not, leave this question blank.

If you are a transfer student, from which school did you transfer and how many hours transferred?

What are your degree plans at this time? Include the Major and Minor, if applicable,. If you are undecided at this time, please indicate this information.

What kinds of financial aid are you receiving? Please check all that apply.

Pell Grant
SEOG
Federal Work Study
Alabama State Grant
Scholarships
Perkins or Stafford Loans

Do you receive any of the following? Please check all that apply.

Social Security Benefits
Vocational Rehabilitation Benefits
Veteran's Benefits
Public Assistance
None of the above

Have you participated in other Trio Programs?

Yes No 

If yes, please indicate which one.

Educational Talent Search
Upward Bound
Student Support Services
Educational Opportunity Center

Who referred you to ASPIRE/Student Support Services?
What was your family's most recent income tax return?
Number of people in your household:	Select from list one two three four five six seven eight More_than_eight
Do you live with your parents?	Yes No
Marital Status:	Select from list Single Married Divorced Seperated Partner
Do you have children?	Yes No

First Generation Status

    "First generation college" status is based on the educational attainment only of the parent(s) or guardian(s) with whom you resided before your 18th birthday.

Do either of the parents/guardians who raised you have a Bachelor's Degree?

  Yes No

I   agree disagree that all of the information provided under First Generation Status is true to the best of my knowledge.

Disability Status

    The ASPIRE Program works in conjunction with the Disability Support Services Office to determine eligibility by this criteria.  ASPIRE can provide these students with academic support and assistance to reduce barriers to success.

Do you have a documented disability?	Yes No
If yes, are you registered with Disability Support Services?	Yes No
I   agree disagree that all of the information provided under Disability Status is true to the best of my knowledge.

Please provide a narrative (essay) in the box below. You may copy and paste a document into the space provided. The personal statement should be at least one full page in length, but no longer than two. Write in complete sentences and organize your information in a logical manner. The narrative should address the following: Describe your educational experience thus far (at school and home; how your educational experience has helped and/or hindered you in becoming the type of person you would like to be; how has your family influenced your education; what your academic/career interests are and why; and why should we admit you into the ASPIRE Program.

Individual Needs Assessment
Check all that apply to you.

Academic Needs

Unsure high school prepared me for college
Achieved a GED
Concerned about my math or writing skills
Unaware of my learning style
Don't know study strategies that work for me
More than 5 years since I've been in school

Majors/Career Concerns

Uncertain about my future career
Don't know what majors would be a good fit for me

Personal needs

Plan to work over 20 hrs/week and attend fulltime
Significant family responsibilities (children, parents)
Significant financial responsibilities outside of school
Entering college as a non-traditional age student
Undecided about whether college is for me
English is a second language

ASPIRE/Student Support Services Admissions Contract

If accepted into the ASPIRE/SSS Program,  I will be eligible for the following benefits:

• Staff people who will serve as my academic mentor, advisor, career counselor, and resource consultant

• Priority Registration during my freshmen and sophomore years, which allows me to register early

• Access to the ASPIRE/SSS computer lab and printing and copying privileges

• Access to the ASPIRE/SSS Textbook lending library and the Laptop Lending Program

• As a freshman or sophomore, possible eligibility  for the ASPIRE/SSS Grant Aid Award

If accepted into the ASPIRE Program, I agree to the following:

• I will attend the ASPIRE/SSS New Student Orientation.

• I will meet with the Project Specialist  at least 2 times each semester.

• As a fall freshman, I will attend the Freshman Retreat.

• If I need academic assistance with any course, I will request tutoring as soon as I recognize a problem.

• I will attend at least 2 seminars each semester to improve my academic, personal, or career skills.

• I will attend the required financial aid and/or literacy sessions.

• I will submit my FAFSA by the April 1 priority deadline, if applicable.

• I will review my mid-term progress reports each semester and discuss my grades with the Project Specialist.

ASPIRE/Student Support Services - Consent to Release

I understand that ASPIRE/Student Support Services needs access to my financial, personal and academic information in order to provide the best possible support for me at the University of Montevallo.  Therefore, I agree to release such information to the ASPIRE/SSS staff members as long as I am considered an active Student Support Services participant or a student at the University of Montevallo.  I further understand that all released material will remain confidential.  Academic information and disability verification, however, will be shared with faculty, university departments, the Director of Disability Support Services, and appropriate representatives of the U.S. Department of Education only as necessary.  I also agree to allow my name and/or picture to be printed in any ASPIRE/SSS newsletter, website, publication, or display in recognition of my academic success, involvement, leadership, or graduation.

I  certify don't certify that I have read and understood this Consent to Release and that I am capable of giving such consent and do so voluntarily.

 

 

For Office Use Only

Eligibility Criteria

[] Low-Income and First Generation

[] Low-Income only

[] First Generation College Only

[] Disability Only

[] Disability and Low-Income

 

Academic Need

[] High School GPA

[] Failing Grades

[] Low Admission Scores

[] Predictive Indicator

[] College GPA

[] GED/Equivalency

[] Returning after 5 or More Years

[] Other/Multiple

[] Lack of Goals

[] Low Academic Preparedness

[] Limited English Proficiency

[] Support for Higher GPA in Major

 

[] Accepted

[] Denied

Reason:

 

Signature of ASPIRE Project Director or Other Responsible Staff

Date: 

 

*Student Support Services is funded by the U.S. Department of Education, Department of Trio Programs.  Acceptance into the program is contingent upon meeting eligibility criteria and space availability.