Educational Opportunity Program TRANSFER VERIFICATION FORM

Transcription

1 Educational Opportunity Program TRANSFER VERIFICATION FORM The student whose name appears on this form is applying for transfer admission to the State University of New York, Educational Opportunity Program. The ability to transfer within Opportunity Programs (EOP, HEOP, SEEK, etc) is intended to facilitate the transition from lower division institutions to upper division institutions and to enable students to make necessary institutional transitions that arise from changes in educational or personal needs while maintaining a continuum of services. Though this option is intended primarily for students who began their college studies in an Opportunity Program, there are specific circumstances in which a student who is not in such a program may be accepted as a transfer. Educational Opportunity Program (EOP) Established in 1967, the Educational Opportunity Program is designed to provide college access to academically and economically disadvantaged New York State residents who would not be able to gain college entry otherwise. Although disadvantaged, students accepted into the program demonstrate the potential to master college-level work. Providing college access to more than 10,000 students annually, the Educational Opportunity Program exists on forty-five campuses in the State University. Admission: To be considered for program admission, applicants must be New York State residents 1. Applicants must also meet the economic 2 and academic criteria established by the, Office of Opportunity Programs. Students accepted into the program are determined to be eligible subject to proof of income and their prior high school performance; documentation must be provided at the time of application. Priority is given to applicants from historically disadvantaged backgrounds. Program Services: Participants of the program receive a range of services including: counseling, tutoring, developmental coursework, financial support, and in some instances, students are required to attend a summer pre-freshman program prior to fall matriculation. To facilitate the transfer admission process, it is important that all sections of the Transfer Verification Form are complete. If you have questions or require assistance in completing the form, please contact the campus to which the student is applying.. 1 New York Residency is defined by the following: (1) Have resided in New York State for twelve months prior to their day of registration in college, or (2) Reside in New York State at the time of application and lived in New York State for the last two terms of high school; or (3) Were residents of New York when they entered military service, Vista or the Peace Corps and re-established New York State residence within six months after completing their term of service. 2 Because the Economic Guidelines change annually, you will need to consult with the EOP administrator to confirm that the student met the economic criteria at the initial point of college entry. This does not apply to campuses with an EOP, HEOP, or Discovery/SEEK Program.

2 This section is to be completed by the campus to which the student wishes to transfer. It is intended to aid the student s previous school in identifying the student accurately. Student is applying for: Fall Semester Spring Semester Academic Year Student Information Last Name First Name Middle Name SSN# or student ID Last Date of Attendance

3 This section is to be completed by the campus from which the student is transferring. It is important that all sections are complete where appropriate. Part I. Please check only one option The student was admitted to the EOP, HEOP, or Discovery/SEEK Program. The student never enrolled in the EOP, HEOP or Discovery/SEEK Program. We do not have an EOP, HEOP, or CD/SEEK program, but the student enrolled in a similar program We do not offer an opportunity program or a similar program Section I. Institution Information 1. Name of Institution Location (City, State, and Country) 2. This institution s academic year is based on: Semesters Trimesters Quarters 3. Select the option that best describes your institution: SUNY CUNY NY Private 4-yr NY Private 2-year Non-NYS Public 4-yr Non-NYS Public 2-yr Non-NYS Private 4-yr Non-NYS Private 2-yr Other Section II. Student Enrollment Data (Complete this section only if your campus has a New York State EOP, HEOP, or CD/SEEK Program) 1. Date of Admission: Fall Spring Summer 2. The student was enrolled in: EOP HEOP SEEK/CD 3. Are you aware of any institutions attended by the student prior to enrolling at your institution? If so, please specify. (Complete this section only if your campus does not have a New York State EOP, HEOP, or CD/SEEK Program) 1. Date of Admission: Fall Spring Summer

4 2. High School Average (at time of application) Combined SAT Score ACT Composite 3. Attended From until Month/Year Month/Year 4. Are you aware of any institutions attended by the student prior to enrolling at your institution? If so, please specify. Section III. Institutions Outside of New York State (Select only one option) 1. Upon college entry, the student was admitted into a program with the same mission as the New York State Educational Opportunity Program. Documentation is attached stating that the student was both financially and academically disadvantaged at the time of admissions. Yes No 2. The student was enrolled in a course of study at a college which has traditionally served underrepresented and financially disadvantaged populations. Documentation is attached stating that the student was both financially and academically disadvantaged at the time of admissions. Yes No Section IV. Program Participation/Enrollment 1. Indicate the specific terms of participation, omitting enrollment in any pre-freshman activities. Please indicate FT for full-time or PT for part-time. If the student enrolled in less than six credits hours, indicate the number of credits. Term FT/PT Term FT/PT Term FT/PT Term FT/PT 2. According to our records, the student has also used eligibility at the following colleges/universities: Institution Name Term 1) Institutions with a New York State Opportunity Program OR 2) Institutions without a New York State Opportunity Program Program Director: Title:

5 Signature: Phone: Date: Signature: Department: Phone: Participating Campuses Date: University Centers Albany 1400 Washington Avenue Albany, New York (518) /81 Binghamton Vestal Parkway East Binghamton, New York (607) Buffalo Capen Hall, Room 501 Buffalo, New York (716) Stony Brook Melville Library, Room W3520 Stony Brook, New York (631) University s SUNY at Brockport 350 New Campus Drive Brockport, New York (585) SUNY at Buffalo 1300 Elmwood Avenue Buffalo, New York (716) SUNY at Cortland P.O. Box 2000, D-116 Cornish Cortland, New York (607) SUNY at Fredonia Central Avenue Fredonia, New York (716) SUNY at Geneseo 1 Circle Geneseo, New York (585) SUNY at New Paltz 75 South Manheim Boulevard New Paltz, New York (845) /21 SUNY at Old Westbury P.O. Box 210, 223 Store Hill Road Old Westbury, New York (516) SUNY at Oneonta Oneonta, New York (607) Ravine Parkway SUNY at Oswego Room 706, Culkin Hall State Route 104 Oswego, New York (315) SUNY at Plattsburgh 101 Broad Street Plattsburgh, New York (518) SUNY at Potsdam 44 Pierrepont Avenue Potsdam, New York (315) SUNY at Purchase P.O. Box 337 Purchase, New York (914) Specialized s of Environmental Science and Forestry 1 Forestry Drive Syracuse, New York (315) Technology at Farmingdale 2350 Broadhollow Road Farmingdale, New York (631) Institute of Technology at Utica/Rome Marcy Campus P.O. Box 3050 Utica, New York (315) Maritime Fort Schuyler Bronx, New York (718) /7348 Technology at Alfred Box 806 Alfred, New York (607) Ceramics at Alfred University Alfred, New York (607) Technology at Canton 34 Cornell Drive Canton, New York Agriculture and Technology at Cobleskill Route 7, Knapp Hall 202 Cobleskill, New York (518) Technology at Delhi 2 Main Street Delhi, New York (607) Agriculture and Technology at Morrisville Administration Building, South Street Morrisville, New York (315) New York State of Human Ecology at Cornell University 227 Day Hall Ithaca, New York (607) Community s Broome Community P.O. Box 1017, 904 Front Street Binghamton, New York (607) Corning Community 1 Academic Drive Corning, New York (607) Dutchess Community 53 Pendell Road Poughkeepsie, New York (845) Erie Community City Campus, 121 Ellicott Street Buffalo, New York (716) Fashion Institute of Technology 227 West 27 th Street New York, New York (212) Finger Lakes Community 4355 Lakeshore Drive Canandaigua, New York (585) X7201 Fulton-Montgomery Community 2805 State Highway 67 Johnstown, New York (518) X8200 Genesee Community 1 Road Batavia, New York ((585) X6521 Hudson Valley Community 80 Vandenburgh Avenue Troy, New York (518) Jamestown Community 525 Falconer Street Jamestown, New York (716) X2348 Monroe Community 1000 East Henrietta Road P.O. Box 9720 Rochester, New York (585) Onondaga Community 4941 Onondaga Road Syracuse, New York (315) Schenectady County Community 78 Washington Avenue Schenectady, New York (518) Suffolk County Community 533 Road Selden, New York (631) Ulster County Community Cottekill Road Stone Ridge, New York (845) X5058 Westchester Community 75 Grasslands Road Valhalla, New York (914) Health Science Centers Health Science Center at Brooklyn 450 Clarkson Avenue, Box 93 Brooklyn, New York (718) Health Science Center at Syracuse 750 East Adams Street Syracuse, New York (315)

6 Please return form to: Name Campus Address Phone

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