NEW STUDENT APPLICATION

2024-2025 Academic Year

Florida Gulf Coast University

10501 FGCU Boulevard S.

Fort Myers, FL 33965

Phone: 239-590-7834   

Fax: 239-590-7947

https://www.fgcu.edu/trio/outreachprograms/

 

Thank you for your interest in the FGCU Outreach Programs. The College Reach-Out Program is a State of Florida grant-funded program designed to prepare middle and high school students to successfully pursue and complete a post-secondary education. The FGCU Scholars Program provides assistance and enrichment opportunities for middle and high school students who aspire to excel academically, develop leadership skills, exhibit citizenship, and serve their community and school.  

INSTRUCTIONS: Before completing the application, please review all questions and the required information. You cannot save and restart this application.

Tenemos hispanohablantes en nuestra oficina disponibles para contestar sus preguntas. 

Nou gen moun ki pale kreyòl ayisyen nan biwo nou ki disponib pou reponn kesyon ou yo.

Selection Process & Eligibility Requirements

Only COMPLETE applications from eligible students will be reviewed. After the initial screening, eligible applicants will be notified by e-mail.

If you should have any questions about this process, please do not hesitate to contact us at 239-590-7834.

 

Part 1: Student Information
First Name *
Middle Name
Last Name *
Preferred Name
Address *
City *
State *
Zip *
County *
Student Cell Phone *
Student Email Address *
Date of Birth *
Current Age *
Gender *
Residency Status *
Race *
Ethnicity *
First Language *
Do you speak English at home?
Current School *
Current Grade Level *
School ID *
Are you taking any Honors/Dual Enrollment/Advanced Placement/International Baccalaureate courses? *

Part 2: Needs Assessment
1. Are you in need of assistance with your academics for better grades?
2. Are you in need of assistance for better study skills development?
3. Are you in need of one-on-one or group tutoring?
4. Do you need help with setting better goals and making wiser decisions?
5. Do you need help developing better money management skills?
6. Do you need help preparing for high school?
7. Do you need help choosing your high school courses?
8. Do you plan on attending college/technical school after high school?
9. Do you need help deciding on a career path that you will enjoy?
10. Do you need help with financial aid or scholarship search?

Part 3: Family Information

(To be completed by Parent or Guardian)
With whom does the student live with? *
Parent/Guardian (#1) First and Last Name *
Relation *
Cell Phone Number *
Work Phone Number
Email Address *
Highest level of education completed in the United States *
Parent/Guardian (#2) First and Last Name
Relation
Cell Phone Number
Work Phone Number
Email Address
Highest level of education completed in the United States
Is your child eligible for the free lunch program at school? *
Number of people living in house *
Which income range listed best describes your household's earnings? *
My signature confirms that the information above is accurate.
Parent/Guardian Signature *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.

Part 4: Parent/Student Consent

CONSENT FOR SERVICES:

I understand pre-college and educational outreach services, including but not limited to: academic advising, tutoring, cultural enrichment activities, career and college exploration, will be provided as needed. Services are provided by TRIO & Outreach Programs staff (counselors, volunteers, mentors, tutors and teachers), and are designed to help students achieve their academic and personal goals. These services are provided free of charge and at the student's will. ALL INFORMATION RECEIVED WILL BE KEPT CONFIDENTIAL IN COMPLIANCE WITH THE FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT.

RELEASE OF INFORMATION:

I authorize TRIO & Outreach Programs personnel to access academic and personal information in the legitimate educational interest of my student including but not limited to: public assistance, free & reduced lunch documentation; standardized test scores (State testing scores, SAT, ACT, GED); report cards; unofficial and official transcripts; attendance records; information about the status of post-secondary education admission/enrollment; financial aid documentation including FAFSA pin code, SAR, and award letters in accordance with The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99). I understand this information is essential in assisting me/my child in preparation for post-secondary education. I further understand all information received is for TRIO & Outreach Programs use only and is held strictly confidential. I intend to give permission for TRIO & Outreach Programs personnel to access and collect this information for the duration of my student's participation in the program and throughout his or her high school and college career; however, if I choose to withdraw this permission, I can call the Program Director at (239) 590-7834

BEHAVIOR AGREEMENT:

I understand that the rules I am held responsible to at my school campus are the same rules that apply during any event with the TRIO & Outreach Programs. If any rule is broken, I understand if it becomes necessary, the TRIO & Outreach Programs staff will call my parents, and they will be required to pick me up IMMEDIATELY. I also understand that failure to abide by any of the recognized rules may result in my dismissal from the TRIO & Outreach Programs.

IMAGE (MEDIA) RELEASE (Please read carefully):

I give TRIO & Outreach Programs permission to record my child's participation and appearance in digital or electronic recordings, videotape, audiotape, film, photography, or any other medium to use my child's name, likeness, voice, and biographical information in connection with these recordings. FGCU may make exhibit or distribute all or any part of these recordings for any educational or promotional purpose, which the university deems appropriate. All such recordings shall remain the university's property.
Emergency Contact:
Name *
Phone Number *
I consent and verify the information provided above is true and complete to the best of my knowledge.
Student Signature *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.
Parent/Guardian Signature *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.