a Division of University of North Carolina at Charlotte --- University Center for Academic Excellence
I am interested in:
(check all that apply)
Choices Learning Community
Freshmen Seminar
Sophomore Seminar
Achiever Application
Building Educational Strengths and Talents (BEST) is federally funded by the U.S. Department of Education. Personal information for record-keeping purposes is required; however, the information you give will be held in confidence.
Name/ID: Last _____ First _____ Middle
UNCC Email: @uncc.edu Banner ID Number: 800
Contact: Street Apt. No.
City State Zip Code
Cell Home
Would you like to receive TEXT notifications? Yes No If yes, at what number
Demographics: Birth Date Gender: Male Female
Citizenship: U.S. Citizen Yes No Resident Alien Number:
Ethnicity:
American Indian / Alaskan Native Native Hawaiian / other Pacific Islander
Asian White (non-Hispanic)
Black / African American Multi-racial
Hispanic / Latino Other
College Level:
Freshman (1-29 hours) Major:
Sophomore (30-59 hours) Concentration (if applicable)
Junior (60-89 hours)
Senior (90+ hours) Minor:
Emergency Contact:
Provide the name of a person to contact if you leave the program, the university, or in case of an emergency.
Name: Relationship:
Cell Home Email
Address: Street Apt. No.
City State Zip Code
(continue on back)
Rev 6/10/2011
It is important that you please answer ALL questions below by filling in the blanks and checking the appropriate boxes.
Check any of the following programs in which you have participated:
Talent Search Gear Up Upward Bound Student Support Services
Ronald E. McNair Post Baccalaureate Program Educational Opportunity Center
Where did you participate in this program?
If you are a transfer student, from what institute are you transferring?
Are you registered with UNC Charlotte’s Office of Disability Services? YES NO
Who was your primary guardian prior to your 18th birthday?
Both Parents Mother Father Other (please identify)
Check all that apply:
None of my guardians have a college degree (proceed to “Authorization to Access Information”)
One or more of my guardians has a college degree. **Indicate degree type below**
2-year degree 4-year degree Name of institute(s)
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Authorizations
I hereby authorize Building Educational Strengths and Talents personnel to access:
1. Financial records to determine my eligibility for services and to report on the sufficiency of funds received.
2. Academic records to determine my eligibility and/or provide needed academic support during my enrollment at UNC Charlotte.
3. Disability documentation to determine my eligibility for the grant.
4. General records of service usage, as well as specific information (i.e. assessment results, feedback, etc.), from sources campus wide, to develop, and/or evaluate my compliance with, my performance plan.
5. Information from other educational institutions including, but not limited to, reported standardized test scores, acceptance and enrollment dates, and progress being made towards the attainment of my current and future academic pursuits.
All of the above information is true and complete to the best of my knowledge.
Student Signature Date
I hereby authorize BEST personnel permission to make my parent(s)/guardian(s) aware of BEST’s blog for families.
Student Signature Date
I hereby authorize BEST personnel permission to text me relevant and/or time-sensitive program-related information.
Student Signature Date
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Applicant Comments:
Applicant Banner ID 800