First Name * Middle Name Last Name * UC Merced Student ID * Are you a U.S Citizen or permanent resident? * Yes No Are you a first generation college student? (Neither of your parents/legal guardian received a degree from a 4-year college) * Yes No Do you or will you receive the Federal Pell Grant? * Yes No Not Sure Are you registered within the Student Accessibility Services (formally "Disability Services") at UC Merced? * Yes No Do you meet at least one of the academic needs listed below? (Please check all that apply) * Low High School Grades (below 2.0 GPA) Low Admissions Test Scores Low Academic Proficient Tests Low College Grades Failing one or more classes Been out of school for more than 5 years Limited English proficiency Lack of education and/or career goals Lack of Academic Preparedness for college level courses Need for academic support to raise grade(s) in required courses/academic major Have you participated in a TRiO Program? * Talent Search Upward Bound Veterans Upward Bound Upward Bound Math and Science Educational Opportunity Centers McNair Student Support Services (SSS) None Sex * Male Female Undisclosed UC Merced Email * Best Contact Number Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021 Ethnic Background * African American / Black Hispanic / Latino Asian / Pacific Islander Native American Caucasian / White Other... Ethnic Background Other... How were you referred to SSS: STEP Scholars Program? Staff and faculty Student / Peers Previous TRiO Program Bright Success Center Staff Publication / Bulletin Board Other... How were you referred to SSS: STEP Scholars Program? Other... Self Needs Assessment * Reading Math English Earth Sciences Physics Chemistry History Other... Self Needs Assessment Other... Self Needs Assessment (Academic Related) * Note Taking Writing Skills Test Taking Time Management Course Selection Research Study Skills Other... Self Needs Assessment (Academic Related) Other... Self Needs Assessment: CAREER * Choosing a Major Choosing a Career Resume Writing Interviewing Skills Job / Internship Search Skills Professional Development Career Mentorship Other... Self Needs Assessment: CAREER Other... Self Needs Assessment: Life Course * Money Management Scholarships Self-Esteem Goal Setting Problem Solving Skills Stress Management Other... Self Needs Assessment: Life Course Other... PARTICIPATION AGREEMNT AND RELEASE OF INFORMATION * As a participant in the TRiO Student Support Services (SSS): "Strengthening Talents & Exploring Pathways" (STEP) at UC Merced, I am committed to my education. To gain the full benefits of the STEP program, I will make a commitment to my academic goals and the assistance provided. Should I not meet the requirements and fulfill my academic goals, it may result in serious consequences regarding my continuation as a participant in the STEP program. I understand and will strive for 100% CLASS ATTENDANCE, 100% CLASS COMPLETION and A MINIMUM GRADE POINT AVERAGE OF 2.00. I also understand STEP staff will review data from my application, academic assessment and interview to assist in assessing my academic and career planning needs. Therefore, all information used will be kept strictly at the highest level of confidentiality. I give the STEP staff permission to inquire about my class attendance, class work, tutoring sessions, and receive grade reports, and I give my instructors permission to release such information to STEP staff when requested. I authorize TRiO Student Support Services to gather information concerning all my academic progress (standardized test scores grade point average, earned credit, transcripts, tutoring, etc.) and financial aid status prior to my participation in STEP. I understand this information is used to help determine my eligibility for STEP and will be kept strictly confidential. I grant permission to STEP to gather information for follow up whenever appropriate, including, but not limited to, transfer and progress to graduate school. I am aware my eligibility and financial aid status will be reported to the U.S. Department of Education in accordance with the grant funding regulations I hereby authorize the use of my photographic image in any and all publications, such as the monthly newsletter, newspaper articles and campus-wide email notices. I authorize STEP to use my name, photo or information about me in promotion of the college through radio, television or other printed materials. I understand my picture could come from a digital image such as my file or from photos taken on various field trips and social events. I grant permission for STEP to review and copy any information maintained as part of my school records including admission, grades, Federal Tax forms, financial aid, disabilities, and any other information pertinent to my status in the University or the STEP program. I certify the information provided on this application is true and complete to the best of my knowledge. I also agree to provide documentation upon request to verify the information reported. I am aware personal information provided to TRiO Student Support Services will be protected under the Federal Education Rights Privacy Act (FERPA) of 1974. No one will have access to the information unless they work with or for SSS, or are specifically authorized by me to see the information BY SUBMITTING MY APPLICATION, I HAVE READ & AGREE TO THE AGREEMENT AND RELEASE OF INFORMATION.
