Arizona State University
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TRiO SSS GATE 2010 Application
July 18, 2010 – July 24, 2010
|Personal Information |
|Name: |
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|Mailing Address (local): |
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|City/State/Zip: |
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|Permanent Address: |
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|City/State/Zip: |
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|Home phone: |Student Email: |
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|Cell phone: |Student ASU Email (if available): |
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|Date of Birth: |Parent Email: |
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|Gender: |ASU ID # (10 digit): |
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|High School Information |
|Name of High School: |Year of Graduation: |
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|Address: |City/State/Zip: |
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|High School GPA: |
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|SAT Score: |ACT Score: |
|Verbal Math |Verbal Math |
|Class Ranking: |
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|Have you taken any dual enrollment/AP courses? YES NO If yes, please list the course and grade earned. |
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|College Information |
|Have you already been admitted to ASU? Yes No |
|Are you registered with the Disability Resource Center ? Yes No (You MUST be registered to be eligible for GATE 2010) |
|Intended major at ASU: |
|What campus will you be attending in the fall? |
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|Tempe Campus West Campus Polytechnic Campus Downtown Phoenix Campus |
|Do you have a FAFSA on file? Yes No |
|Are your MMR records on file with the ASU Health and Wellness Center? Yes No |
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|TRiO SSS Information |
|What previous enhancement services (e.g. counseling, tutoring, and study skills assistance) have you received in elementary school, high school, or college? |
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|Would you like to work with an instructional specialist to learn disability specific strategies in math, reading, social science or and/or writing? Yes No |
|Please check the box for courses for which you would like to request tutoring: |
|Biology Chemistry Communications |
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|Math Psychology/Sociology |
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|Reading Writing Other: |
|Please check areas in which you would like assistance, instruction or information: |
|Career Guidance Financial Aid Reading Stress Management Writing Math Study Skills |
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|Time Management Coping with College Other: |
|Essay – IMPORTANT! Please be thoughtful in your response. |
|In one or two paragraphs, please explain how your participation in GATE 2010 will help you meet your academic and career goals. Include information about special |
|circumstances or challenges that you would like the committee to take into consideration in reviewing your application. |
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By submitting this application, I agree to the following: If accepted into the GATE 2010 program, I will attend ASU during the fall semester. On behalf of the Family Education Rights and Privacy Act of 1974, I hereby authorize the release of my records in reference to academic transcripts, degree plans, personal assessment test scores, and any other academic related information to the DRC and TRiO staff.
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Student Signature Date
A complete GATE 2010 application consists of:
1. This completed and signed form
2. A copy of the first two pages of the parent/s 2009 tax return
You may submit your application packet by email, US Mail or fax. THE APPLICATION DEADLINE is May 15, 2010.
Email: karen.caldwell@asu.edu
US Mail:
Karen Caldwell/GATE
PO Box 873202
Tempe, AZ 85287-3202
Fax: 480-965-0441
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