University of Montevallo - Student Support Services

Student Support Services

ASPIRE
Student Support Services

Online Application Form

ALL DATA MARKED WITH AN ASTERISK IS REQUIRED.

If you require an alternate format or need assistance completing this form please contact the ASPIRE Program Main Office at 205-665-6250.

The application is not complete until you have submitted your application.

APPLYING FOR ADMISSION TO PROGRAM IN:

*FALL SEMESTER:

*SPRING SEMESTER:

BASIC INFORMATION

*UM ID:

(i.e.M12345678)

*Date of Birth:

(i.e. mm/dd/yyyy)

*Last Name:

*Gender:

*First Name:

*U.S. Citizen?

Yes No

Middle Initial :

*Permanent Resident?

Yes No

*Home Address:

*Preferred Phone Number:

(i.e. xxx-xxx-xxxx)

*City:

*Alternate Phone Number:

(i.e. xxx-xxx-xxxx)

*State:

*UM E-mail Address:

(i.e. student@forum.montevallo.edu)

*Zip Code:

Campus Address (if applicable):

*Ethnicity:

Select all that apply from the menu.

American Indian/Alaskan Native

Native Hawaiian/Pacific Islander

Asian

White

Black or African American

Hispanic

Emergency Contact Information

*Name:

*Relationship:

*Address:

*Phone Number:

(i.e. xxx-xxx-xxxx)

EDUCATIONAL BACKGROUND

*Type of Education:

Year H.S. degree or G.E.D. Obtained:

If High School Degree, Name of High School

*College Grade Level:

Number hours transferred:

*Transfer Student?

Yes No

If transfer student, Institution:

Did you earn an AA or AS Degree?

Yes No

If AA or AS, Year:

ELIGIBILITY INFORMATION
All sections must be completed; Incomplete information may delay review of your application.

*1. Income Status of Student:

Please select the income range that most reflects your family's taxable income for 2011.

Are you a:

Dependent Student Independent Student

Dependent Students live with and are supported by, parent/guardian unless living away to attend school
Independent Students are either 24 yrs. old, married, have children, U.S. Veteran, or in Foster Care, Ward of the Court/Emancipated Minor

Did you apply for or are you currently receiving financial aid?

Yes No

My initials confirm that this information is true to the best of my knowledge

*2. First Generation College Status of Student:

Does/did either parent with whom you lived before your 18th birthday, have a Bachelor's (4-year) degree?

Yes No

My initials confirm that this information is true to the best of my knowledge.

*3. Disability Status of Student:

Do you have a federally recognized disability?

Yes No

If yes, have you registered with the UM Disability Support Services? * Yes No
* Disability information must be verified with the Disability Support Services Office.

NEED FOR ACADEMIC SUPPORT

Please check one or more of the statements below:

I was placed in MATH 131.

My Composite Score of my ACT was lower than 20; and/or my Math, English or Writing SAT score was below 500.

My current GPA is between 1.0 and 2.49.

I currently am on Academic Warning/Probation.

I need to raise or maintain grades to reach a specific career goal or gain admission to my major program.

I don't know which majors would be a good fit for me.

I am a non-traditional college student.

I don't know how to select a major or a career.

I am unfamiliar with study strategies that might help me succeed in some courses.

I am unsure that high school prepared me for college.

I have significant financial and/or family responsibilities.

I have no idea how to select appropriate courses that would lead to graduation.

I am uncertain about whether or not college is for me.

RELEASE OF INFORMATION

Please review and place your initials and date as indicated.

	*I hereby authorize the ASPIRE/SSS Program to obtain, review and discuss my records with those concerned about my academic progress and success such as faculty, financial aid, Dean’s Office, and other appropriate offices. I also agree to allow my name and/or photograph to be used in newsletter, marketing/recruitment materials to recognize my academic success, involvement, leadership or graduation.
	*I agree to check in with the ASPIRE staff and to use the support I need to be successful. I am committed to earning a bachelor’s degree at the University of Montevallo and will inform the program immediately if I change my plans.
	*I certify the information given in this application is complete and accurate; and I understand that to make false or fraudulent statements within this application may result in denial of admission to the ASPIRE Program.

Application Checklist

(please use checklist as a guide and submit with your application)

Completed all required information on application

Entered my initials where required

Know that I must provide proof of family income