Access, Opportunity, & Success Release Of Information Form (Page 2 of 2) in pdf

Access, Opportunity, & Success Release Of Information Form Page 2

Access, Opportunity & Success Academic Outline

Academic Indicator/Need Form

Confidential Information

PLEASE NOTE THAT THIS IS NOT A SCHOLARSHIP PROGRAM:

Regulations require that all participants in AOS programs demonstrate academic need in order to

receive program services. All AOS participants are expected to meet with a program advisor and

engage in other program sponsored activities during the academic year.

AOS offers assistance in the following areas, if accepted what services are you most likely to use?

Yes___

No___ Academic Advising (Course selection/ registration, long-term planning)

Yes___

No___ Financial Aid Counseling (Award letter evaluation, FAFSA, application process)

Yes___

No___ Academic Counseling (Goal setting, progress monitoring)

Yes___

No___ Study Skills Development (Workshops or individual)

Yes___

No___ Personal/Social Advising (i.e. transition to college, work, etc.)

Yes___

No___ Graduate School (Internships, and/or fellowships)

Yes___

No___ Career Counseling (Planning, employment strategies, resume building, interviewing skills)

Yes___

No___ Self-Advocacy Skill Building

Yes___

No___ Campus Climate Issues

Yes___

No___ Other: please state specific areas in which you would like assistance

What circumstances may affect your studies at Southwest Minnesota State University?

In the space below, write a short paragraph stating why you are applying to Southwest Minnesota State University AOS.

Comment on your expectations, benefits you hope to receive, and what commitments you are willing to make.

By signing this document, I am verifying areas in which I would like assistance.

___________________________________________________

_______________

Student’s Signature of Release

Date

_________________________

Mustang ID

●Return to Academic and Diversity Resources● Southwest Minnesota State University●1501 State Street, IL 220●Marshall, MN 56258●

●Fax: 507-537-6027● Phone: 507-537-7382● Email: Michele.Sterner@smsu.edu ●

Access, Opportunity, & Success Release Of Information Form Page 2