Summit Scholars Application Form

Please complete this application so we can better understand your goals and determine your eligibility, allowing us to provide the support and resources that best help you succeed in college. We will contact you via your student email address after we have reviewed your application.

Student Legal Name*

Student Legal Name

First Name Middle Name Last Name

Student Chosen Name (optional)

Student Chosen Name

Chosen First Name Chosen Middle Name Chosen Last Name

Student Email:*

Mobile Phone:*

Student ID:*

Date of Birth:*

If any of the above information is incorrect, please email Registration and Records and someone will provide assistance.

Emergency Contact Person*

Emergency Contact Person

First Name Middle Name Last Name

Emergency Contact Phone #*

Emergency Contact Relationship*

Student Legal Sex:*

Student Gender Identity:*

What is your ethnicity?*

American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White
Prefer not to respond

Preferred Pronouns:*

Eligibility Criteria:*

What is your primary language*

Did you graduate from high school?*

Yes No

Highest Degree Completed:*

First-Generation Status (Select one):*

Disability Status Verification (Select one):*

Have you completed the Free Application for Federal Student Aid (FAFSA) form?*

Yes No

Reasons for joining TRIO Summit Scholars (check all that apply):*

Improve grades
Transfer to a four-year college
Career guidance
Financial aid assistance
Other (please specify):

Support needed (Check all that apply):*

Academic
Financial
Family obligations
Work schedule
Transportation
Mental health
Housing
Other (please specify):

Please read the following statement carefully before signing:

I certify that, to the best of my knowledge, all the information provided above is accurate. I also authorize the TRIO Summit Scholars to access academic, financial, and personal information relevant to the TRIO Summit Scholars services I may receive. I understand that providing false information may result in denying TRIO Summit Scholars services. Furthermore, I agree to notify the TRIO Summit Scholars office immediately if any of the information above changes.