Paper Application. First Name: MI: Last Name: Preferred Name (if any): Current mailing address: City, State, Zip:

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Paper Application University of Southern Maine TRIO Student Support Services General Information First Name: MI: Last Name: Preferred Name (if any): Current mailing address: City, State, Zip: Email:

1 Paper Application University of Southern Maine TRIO Student Support Services General Information First Name: MI: Last Name: Preferred Name (if any): Current mailing address: City, State, Zip: _ Best phone number to reach me: Is this a cell number? Yes No Is it permitted to text your cell? Yes No Carrier/Service Provider: Date of Birth: / / Social Security Number: / / Gender: *Gender is used by the TRIO office to prepare summary data reports to the Federal and other government agencies. It will not be used in any way to determine your acceptance into TRIO Student Support Services. Eligibility Information: Students are eligible to apply for TRIO Student Support Services at USM if they meet the following U.S. Department of Education guidelines. Please check all that apply to you: 1. I am enrolled in a USM degree program or accepted for enrollment at USM. 2. I am permitted to apply for Federal financial aid as a United States citizen or eligible noncitizen. 3. I am or will be working on completing my first bachelor s degree. 4. I am in need of academic support. 5. And meet at least one of the following criteria: A. The parents/legal guardians that you regularly resided with prior to age 18 have not graduated with a Bachelor s degree (4-year degree). B. I meet government income guidelines based on the chart below. C. I have a documented physical, medical, psychological, or learning disability that is registered with the USM Disability Services Center (DSC).

2 Federal TRIO Programs Current-Year Income Levels (Effective January 18, 2018 until further notice) Size of Family Unit 48 Contiguous States, D.C., and Outlying Jurisdictions Alaska Hawaii 1 $18,210 $22,770 $20,940 2 $24,690 $30,870 $28,395 3 $31,170 $38,970 $35,850 4 $37,650 $47,070 $43,305 5 $44,130 $55,170 $50,760 6 $50,610 $63,270 $58,215 7 $57,090 $71,370 $65,670 8 $63,570 $79,470 $73,125 For family units with more than eight members, add the following amount for each additional family member: $6,480 for the 48 contiguous states, the District of Columbia and outlying jurisdictions; $8,100 for Alaska; and $7,455 for Hawaii. How do I read the federal income chart? If you have 3 people in your household and your taxable income was $15,625, then your income would fall below the cut off of $31,170 for the 48 contiguous states. You would then be income eligible to apply to TRIO Student Support Services. What is considered family unit? Family unit is defined as the total number of persons who are related to you by blood, marriage or adoption and are dependent on the head of household for support. A stepparent or stepchild in considered related by marriage. Where do I find my taxable income information? You can use your most recent federal income taxes. IRS Form 1040 Line 43 IRS Form 1040A Line 27 IRS Form 1040EZ Line 06 *The parents /legal guardians federal tax return must be used if they claimed the student as a dependent on their 2017 income tax return, or if the student was under 24 years old, single and not a veteran. The student s federal tax return must be used if the student was not claimed as a dependent and was 24 or older, or is a veteran, or was married (spouse s 2017 income should be included).

3 Academic Information MaineStreet ID Number: Your Primary USM Campus: Gorham Portland Lewiston Unknown Intended Major(s): Intended Minor(s): What semester are you at USM? When are you planning to join/start TRIO SSS? I would like to start this summer 2018 in the TRIO Summer Bridge program. I am a current USM student, and would like to join TRIO SSS now. I would like to join TRIO SSS at the start of the fall 2018 semester. I would like to join TRIO SSS at the start of the spring 2019 semester. How many college credits have you completed? High School/College GPA (use most recent): What is your estimated date of graduation? (month and year) / Are you currently on academic probation at USM? Yes No Have you previously been on academic probation at USM? Yes No Have you taken ESOL/ELL courses? Yes No If taken, what was your new (March 2016 and beyond) Evidence-Based Reading and Writing SAT score? If taken, what was your new (March 2016 and beyond) Math SAT score? If taken, what was your old (prior to March 2016) Critical Reading SAT score? If taken, what was your old (prior to March 2016) Math SAT score? If taken, ACT score: If taken, TOEFL score: Please check off classes you are currently enrolled in and/or may need academic support: Math 009 Math 101B Other Information Are you planning to transfer to another institution before graduating with a bachelor's degree from USM? Please circle an answer: No Unsure Yes Are you currently employed? No Yes 1-9 hrs/wk hrs/wk hrs/wk hrs/wk 40+hrs/wk

4 *Please mark one of the following ethnic identities: Hispanic or Latino OR Not Hispanic or Latino AND *Please choose from the following racial identities, you may select more than one: American Indian or Alaskan Native Native Hawaiian or other Pacific Islander Asian Black or African American White *Ethnic and racial identity is used by the TRIO office to prepare summary data reports to the Federal and other government agencies. It will not be used in any way to determine your acceptance into TRIO Student Support Services. Have you formerly participated in another TRIO program? Please check off all that apply. No Yes, Equal Opportunity Center (EOC) Yes, Educational Talent Search (ETS) Yes, GEAR UP Yes, TRIO Student Support Services (SSS) Yes, Upward Bound (UB) Yes, Upward Bound Math/Science (UBMS) Yes, Upward Bound Veterans Were you previously enrolled in Jobs for Maine Graduates (JMG) in high school? Yes No Are you currently participating in Jobs for Maine Graduates (JMG) at USM? Yes No Have you been in or currently in foster care? Yes No Have you earned your high school equivalency diploma (GED or HiSET) through an alternative program within the previous five years? (did not graduate from a high school) Yes No Please check off all of the ways you heard about the TRIO SSS program. TRIO staff member presented in your class(es) TRIO staff member at a table Professor/Instructor Professional Advisor USM Staff member Disability Services Center (DSC) RA (Resident Assistant) Friend Parent/Guardian Campus Visit Day Admission Open House Admitted Student Day Flyer/poster posted on campus Postcard in mail Bulletin board TV screen(s) on campuses TRIO SSS banner on campus Table tent (flyer on table) Website Other, please share: Why did you decide to enroll in college?

5 Do you have any challenges that may hinder your success at college? If yes, please share how you plan to overcome those challenges. I hereby apply for services in the TRIO Student Support Services (SSS) program at the University of Southern Maine (USM). I certify that the information I have supplied on this form is true and accurate, to the best of my knowledge. I understand that the TRIO program can share and receive information for my educational benefit with other USM offices, staff, and faculty according to the Family Rights and Educational Privacy Act (FERPA) of I understand that I may withdraw from this program at any time. Student Signature: Date: Please submit this application and materials to any of the following campus locations: TRIO Programs Office Other Office Locations 7 College Avenue, Gorham 102 Bedford Street, Portland Ph: Lewiston-Auburn College, Lewiston Fax: Bailey Hall, Gorham, You may also us at triousm@maine.edu or visit our website: for additional information. Equal Opportunity Policy. In complying with the letter and spirit of applicable laws and pursuing its own goals of diversity, the University of Maine System shall not discriminate on the grounds of race, color, religion, sex, sexual orientation, including transgender status or gender expression, national origin, citizenship status, age, disability, or veteran's status in employment, education, and all other areas of the University System. The University provides reasonable accommodations to qualified individuals with disabilities upon request. Questions and complaints about discrimination in any area of the University should be directed to the campus Equal Opportunity Director; for contact information visit

APPLICANT INFORMATION. Area Code: Phone: Area Code: Phone:

APPLICANT INFORMATION. Area Code: Phone: Area Code: Phone: MARQUETTE UNIVERSITY HEALTH CAREERS OPPORTUNITY PROGRAM College Science Enrichment Program (CSEP) & Pre-Enrollment Support Program (PESP) Website: http://www.mu.edu/hcop INSTRUCTIONS: Please type or print