TRIO ETS is a federally funded college access program at UAA that provides postsecondary preparation to first‐generation and limited‐income students. Services include advising, college and career exploration, tutoring, workshops, field trips and more! ETS students must be citizens or permanent residents of the United States. All services are FREE!

Student First Name *

Student Middle Name

Student Last Name *

School Name *

Current Grade Level *

Social Security Number *

Mailing Address *

Mailing City *

Mailing State *

Mailing Zipcode *

Date of Birth (MM/DD/YYYY) *

Age *

Gender *

Phone Number *

Allow texting? *

Email *

Citizenship *

Permanent Resident A#

Ethnicity

Please select all that apply.

Are you Hispanic/Latino? *

Black/African American

White/Caucasian

American Indian/Alaska Native

Asian

Native Hawaiian/Pacific Islander

Parent Information

Parent/Guardian Information *

Specify 'Other' or write N/A *

Parent #1 Name *

Address *

City *

State *

Zipcode *

Phone Number *

Email *

Employer *

Parent/Guardian Information *

Specify 'Other' or write N/A *

Parent #2 Name *

Address *

City *

State *

Zipcode *

Email *

Phone Number *

Employer *

This program is federally funded, and the following information is required in order to process your application.
This information will remain confidential if you have any questions, please use the contact info below.

Has your natural/adoptive Parent 1 completed a 4‐year bachelor’s degree? *

Has your natural/adoptive Parent 2 completed a 4‐year bachelor’s degree? *

Who does the student live with over 50% of the time? *

Specify 'other' or write N/A *

Income Eligibility

Use most recent tax year.

How many people in your household? *

Taxable Income *

Does student qualify for free or reduced lunch? *

Is another language other than English spoken at home?

If yes, what are all other languages spoken?

If yes, what is the preferred language when speaking to parents/guardians?

Are you or a relative currently in TRIO ETS, Upward Bound (UB) or Student Support Services (SSS)? *

If yes, what is the relatives full name?

What is the relatives relation to you?

Which program?

General Student Information

Select all that apply.

I am in Foster Care

I was an orphan or ward of the court prior to age 18

I am homeless or living with friends

I am a Veteran of the United States Military

I am married

I have children or dependents that I provide over half of their support

I do not live with a legal guardian or parent

Explain

None of these Apply to me

Student Questionnaire

Academics

I need to learn to take better notes. *

Taking tests or quizzes is difficult for me *

I need to learn or develop study habits *

Improving my GPA is important *

I struggle with Math *

College

I would like to visit a college campus *

I would like to learn about Financial Aid *

I need help completing college applications *

I would like help with scholarships *

Careers

I have a career plan *

I would like to visit business to explore careers *

I need resources to explore careers *

I would like to learn how to find a job *

I need help understanding my abilities/Interests *

General

I would like to manage my time better *

I have access to a computer at home *

I have good internet at home *

I need help with organization *

How did you hear about the program? *

In case of emergency and the parent/guardian cannot be reached please contact:

Name *

Phone Number *

Relationship *

Information Release

In order to best serve TRIO ETS participants in the areas of educational planning and postsecondary enrollment, it is critical for ETS personnel to have access to the following educational records. I give my permission for project staff to request and receive any educational records regarding my child such as:

Class schedules, transcripts/grades, scores for standardized achievement, college placement and diagnostic tests/assessments, discipline records, attendance records, graduation verification, free lunch verification and/or financial aid data, special programs records (this includes all special services your student may receive, such as special education) and other reports or academic data required for admission and participation in the ETS program and necessary to provide effective services and track education outcomes for the applicant.

I hereby give my permission for my child to participate in all TRIO ETS activities. I hereby give my permission for my child’s name, photograph, work, and/or statements to be used by TRIO ETS for promotional, publicity, or instructional purposes.

Signatures

FOR ALL PARENTS/GUARDIANS: I certify that the information on this form and any attachments are true, complete
and accurate to the best of my knowledge. In addition, I agree to the information release above.

Parent/Guardian Signature *

Please select a signature verification type.

Date Signed *

Student/Applicant Signature *

Please select a signature verification type.

Date Signed *

Call or email Kaitlin DeMarcus (Director) with any questions: Work Cell: 907‐538‐8746 (TRIO); Email: kbdemarcus@alaska.edu