Please prepare to spend at least 30 minutes completing this form. The form can be completed on any electronic device.

Student Contact Information

Student Demographic Information

Gender: 

First Generation Status Information

Does your Mother have a Bachelor's (4-year college) degree?
Does your Father have a Bachelor's (4-year college) degree?

Student Dependency Information

Are you married?
Do you have children?
Have you ever been a ward of the court, in foster care, or an emancipated minor?
Serving active duty in the armed forces?
Active duty U.S. Veteran released under any condition other than dishonorably?
Are you under 18 years old with no parents or guardians?
Are you homeless or at risk of becoming homeless?

Student Participant Agreement With WEI Student Support Services

By accepting the student into the project, WEI agrees to provide the following:
  1. Educational support services for student (identified through needs assessment).
  2. Assistance in receiving and maintaining financial aid.
  3. Assistance with career exploration and planning.
  4. Referrals to other agencies as needed.
  5. College transfer assistance as needed.
By electing to participate in the WEI program, I agree to full participation as follows:
  1. I will meet with my WEI advisor at least one time per semester that I am enrolled in WEI, or more as identified by my advisor throughout the school year.
  2. I will attend class(es).
  3. I will ask for educational support as soon as my grade falls below a "C" in any course.
  4. I will attend scheduled meetings with WEI staff or will contact WEI staff to reschedule.
  5. I will attend all scheduled tutoring sessions funded by the program, or will cancel by calling the WEI Office at least 24-hours in advance.
  6. I will complete and submit all required financial aid forms on time as required.
  7. I release authorization for the WEI program to request any and all academic and non-academic documents related to my academic progress.
  8. I agree to allow the WEI program to add my Phone number to the participant list to receive text messages. Participants agree to inform program when phone number or address change.

If I do not comply with Items 1-7 above, I might not be entitled to receive those services reserved specifically for WEI students.
For the ability to participate in the program: 

WEI Student Needs Assessment

Current Status
Educational Assessment (Part 1)
Have you ever had your ability to read, write or do math assessed before coming to PSC?
Have you ever taken assessment tests at PSC?
If yes, check all that apply.
Did you receive a General Equivalency Diploma?
Did you graduate from high school?
Other Post Secondary College:
Were your transcripts evaluated?
What are your educational goals? Check all that apply:
Educational Assessment (Part 2)

Rate yourself from 1 to 5 for each of these questions
1 - No - strongly disagree
2 - Below average - disagree
3 - Ok - average or sometimes
4 - Pretty good - agree
5 - Yes - strongly agree
Answer the following questions.
Transfer Assessment
Do you intend to transfer to another college or university? 
Do you need transfer assistance? 
Have you applied to any other colleges? 
Personal Assessment
Are there personal issues in your life that may affect your ability to succeed in college? Consider issues related to yourself, family and friends. 
Are you currently involved in any clubs or organizations? 
Are you interested in becoming involved in any clubs or organizations at PSC? 
Is transportation a problem for you? 
Is childcare a problem for you? 
Are there any other issues that may make it difficult for you to succeed in college? 
Computer Competencies
Do you have an internet connection at home or away from campus? 
Do you own and have regular access to a computer? 
Do you have access to or have you begun using your PSC e-mail, username and password? 
Financial Assessment
Are you employed? 
Would you be interested in finding a different job? 
Do you need financial aid? 
Have you ever applied for Financial Aid? 
Are you receiving financial aid now? 
Types: (Check all that apply)
Disabilities
If so, have you contacted the ADA Coordinator?
Have you supplied documentation to the ADA Coordinator?
Would you like us to send you more information on disability services? 

Student Verification

Date: Monday, 5 December 2022 (EST)
Name:
Type your name to sign this document:
Typing name is equivalent to a handwritten signature
Signature