INSTRUCTIONS TO COMPLETE THE
DEPARTMENT OF PUBLIC INSTRUCTION
WISCONSIN EDUCATIONAL OPPORTUNITY PROGRAMS (WEOP)
STUDENT APPLICATION (PI-WEOP-1000)
· Please type or print.
· If you are currently enrolled in grades 6, 7, 8, 9, 10 or 11, complete sections I, II, IV and V.
· If you are currently a senior in high school or older, complete sections I, II, and III.
SECTION I: STUDENT INFORMATION
This section should include the student/applicant’s information.
All applicants must complete this section.
1. Student Name: Please indicate your last name, first name, and middle initial if you have one.
2. Social Security Number: Your number is for official purposes only and will not be released without written permission from the applicant and their parent/legal guardian if a dependent. If you do not have a social security number, please indicate that in the space.
3. Gender: Indicate if you are male or female.
4. Date of Birth: Indicate month/day/year.
5. Home telephone number along with area code.
6. Cell phone number along with area code.
7. Email Address: Please list your email address. If you do not have an email address, please indicate NONE.
8. Mailing address: List your street address, city, county, state and zip code where you will receive your mail.
9. School ID Number: If you have a school ID number, please list it.
10. School District of Residence: Indicate the name of the school district where you attend. If you do not attend a secondary school, please indicate the school district where you reside.
11. Current Grade Attending: If you are attending middle or high school, please indicate your current grade.
12. School Information: List the name of the school you are currently attending. If you are not attending a secondary school, please indicate the school that you previously attended as well as check if it is a middle or high school.
13. School Address: List the address, city, county, state, and zip code of the school previously listed.
14. Year of Graduation: List the year that you graduated from secondary school or the year that you will graduate.
15. Ethnicity: Choose if you are Hispanic/Latino or Not
16. Race: Please check your race. You can indicate more than one race if necessary.
SECTION II: HOUSEHOLD INFORMATION
All applicants should continue to complete Section II with the applicant/student’s information.
1. Who do you live with? Please check all that apply.
2. Have you lived in Wisconsin the past five years? Check Yes or No. If no, please indicate number of years you have lived in Wisconsin.
3. U.S. Citizen. Check Yes or No. If no, please check yes or no if you are a permanent resident. You will be required to provide a copy of your Green Card/Alien Registration Card if you are applying for the Federal TRIO Talent Search or Upward Bound Programs.
4. Mother’s Last and First Name.
5. Father’s Last and First Name.
6. Mother’s work telephone number along with area code.
7. Mother’s cell phone number along with area code.
8. Father’s work telephone number along with area code.
9. Father’s cell phone number along with area code.
10. Mother’s email address.
11. Father’s email address.
12. Mother completed a four-year college degree: Check yes or no.
13. Father completed a four-year college degree: Check yes or no.
14. Mother speaks English: Check yes or no. If no, indicate what language she speaks.
15. Father speaks English: Check yes or no. If no, indicate what language he speaks.
16. People living in the household: Indicate the number of people living in your household including yourself. Do not include non-relatives or individuals that you or your parents do not support.
17. Family taxable income: If you and/or your parent(s) filed a federal tax return for the previous year, indicate the amount listed from the line “taxable household income.” If you and/or your parent(s) did not file a tax return for the previous year, please indicate your non-taxable income for the previous year. If you live with only one parent, include only that parent’s income. If that parent is remarried, you must also include the step-parent’s income.
18. Benefits: Check which benefits your family receives. Check all that apply.
19. Enrolled in other TRIO or GEAR UP programs. Check yes or no. If yes, please indicate which programs.
SECTION III. COLLEGE PLANS
Only an applicant who is a high school senior or older, should complete this section.
1. Name of College Planning to Attend: Indicate the name of the school you are applying to and indicate its street address, city, state, and zip code.
2. Second Choice: Indicate if you are applying to another college and indicate its street address, city, state, and zip code.
3. What do you plan to study: Indicate your major. If you have no major, list undecided.
4. Length of program: Indicate if it is a 1 year, 2 year, 4 year or other type of degree.
5. Date school begins: Indicate month and year if you do not know the exact date.
6. Have you applied for admission: Indicate yes or no.
7. Have you applied for financial aid: Indicate yes or no.
8. Currently or previously enrolled in college: If you are enrolled in college now or previously attended a postsecondary institution, please check yes and indicate where.
9. Date entered: Indicate when you will begin college or if you previously attended college, when you began.
10. Date left: If you left college, indicate when.
11. Number of credits earned: If you previously attended college, list number of credits you completed.
12. Precollege test taken: Indicate which precollege entrance test you took.
13. GED: If you completed a GED, indicate the date and location it was received.
TALENT INCENTIVE PROGRAM (TIP) GRANT CRITERIA.
To be eligible for an initial TIP award, a student must be a Wisconsin resident, a first-time freshman student, attending an approved Wisconsin college/university, and meet at least one criterion under Group A and Group B.
1. Under Group A, check all that apply.
2. Under Group B, check all that apply.
If you must complete the FAFSA (Free Application for Federal Student Aid) using a parent(s) income information, then you are considered a dependent student for TIP purposes. If you are not required to use parent(s) income information on the FAFSA, then you are considered an independent student for TIP purposes.
STUDENT/PARENT SIGNATURES:
1. Student/applicant sign and date.
2. Parent sign and date if the student is a dependent student for financial aid purposes.
WEOP OFFICE USE ONLY (shaded section)
This section is for WEOP staff use only.
SECTION IV and V: STUDENT PLEDGE and STUDENT AND PARENT COMMITMENT
This section should only be completed by students who are currently in grades 6, 7, 8, 9, 10, or 11.
1. Please read the pledge.
2. Student sign and date
3. Parent sign and date
SECTION VI. VERIFICATION
This section is for WEOP staff use only.
· PLEASE RETURN THE COMPLETED APPLICATION TO THE NEAREST WEOP OFFICE THAT YOU ARE LOCATED.
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