A
DIVISION OF UNIVERSITY OF NORTH CAROLINA AT CHARLOTTE --- UNIVERSITY CENTER FOR ACADEMIC EXCELLENCE
I am interested in:
(check all that apply)
BUILDING EDUCATIONAL
STRENGTHS & TALENTS
Choices Learning Community
Freshmen Seminar
A FEDERAL STUDENT SUPPORT SERVICES TRIO PROGRAM
Sophomore Seminar
Ac h i e ve r Ap p l i c a t i o n
Building Educational Strengths and Talents (BEST) is federally funded by the U.S. Department of Education. Personal information for recordkeeping purposes is required; however, the information you give will be held in confidence.
Name/ID: Last _____ First _____ Middle
UNCC Email:
Contact:
@uncc.edu
Street
800
Apt. No.
City
Cell
Banner ID Number:
State
Zip Code
Home
Would you like to receive TEXT notifications?
Yes
Demographics: Birth Date
No
If yes, at what number
Gender:
Citizenship:
U.S. Citizen
Yes
Male
No
Female
Resident Alien Number:
Ethnicity:
American Indian / Alaskan Native
Asian
Black / African American
Hispanic / Latino
Native Hawaiian / other Pacific Islander
White (non-Hispanic)
Multi-racial
Other
College Level:
Freshman (1-29 hours)
Major:
Sophomore (30-59 hours)
Junior (60-89 hours)
Concentration
Senior (90+ hours)
(if applicable)
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
Address:
Street
City
Home
Email
Apt. No.
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
Ronald E. McNair Post Baccalaureate Program
Student Support Services
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
Return Application to:
University of North Carolina at Charlotte
Building Educational Strengths & Talents
9201 University City Boulevard
314 Fretwell Building
Charlotte, NC 28223
704-687-2851 Phone
704-687-3550 Fax
best@uncc.edu
Office Use Only
Eligibility:
Entry Dates:
GPA:
Placement:
Status:
Appeal:
Acceptance:
FG ______ LI ______ DI ______
B.E.S.T. Project ____________ UNC Charlotte ___________
Actual _________ Predicted _________ Transfer _________
SATCR:______ SATM:______ SATW:______ Math:________
Enrollment ____________ Entry Grade ____________
Academic Need ____________________________________
Yes _____ No _____ Need Info _____ Wait List _____