NEW STUDENT APPLICATION

 TRIO & Outreach Programs

2025-2026 Academic Year

Florida Gulf Coast University

 10501 FGCU Boulevard S.

Fort Myers, FL 33965

Phone: 239-590-7834   

 Fax: 239-590-7947

https://www.fgcu.edu/trio/outreachprograms/

 

Selection Process & Eligibility Requirements

Only COMPLETE applications will be reviewed. After the initial screening, eligible applicants will be notified by e-mail.

Participation in the program is granted first to applicants that meet the following criteria:

  • Enrolled at one of the following target schools -
    • Lehigh Acres Middle School
    • Dunbar High School
    • East Lee County High School
  • Potential First-Generation Student (neither parent or legal guardian have obtained a Baccalaureate (BA) degree)
  • Income eligible as determined by federal low-income standards
  • US Citizen or Permanent Resident

If you should have any questions about this process, please do not hesitate to contact us at 239-590-7834.

Part 1: Student Information 

 
Student's First Name *
Middle Name
Student's Last Name *
Preferred Name
Address *
City *
State *
Zip *
Student Cell Phone *
Student Personal Email *
Student School Email *
Current Age *
Date of Birth *
Gender *
Residency Status *
Race/Ethnicity *
Current School *
If you chose "Non-Target" as your current school, please provide your current school's name below:
Non-Target School Name
Current Grade Level *
School ID (eight digits) *
Are you taking any Honors/Dual Enrollment/Advanced Placement/International Baccalaurate courses? *
What are your plans after you graduate highschool? *
How did you hear about us? *

Part 2: Needs Assessment

1. Are you in need of assistance with your academics for better grades?
2. Are you in need of assistance for better study skills development?
3. Are you in need of one-on-one or group tutoring?
4. Do you need help preparing for state testing or college placement?
5. Do you need help choosing your classes?
6. Do you need help deciding what your milestone courses are?
7. Is English your first language? 
8. Do you need help deciding on a career path? 
9. Do you need help exploring college options? 
10. Do you need help with financial aid, scholarship search, FAFSA, or college applications? 

Part 3: Family/Income Information 

 (To be completed by Parent or Guardian)
With Whom Does the Student Live? *
First and Last Name (Parent/Guardian #1) *
Relation *
Cell Phone Number *
Work Phone Number
Parent's E-mail Address *
Highest level of education completed by Parent/Guardian #1 *
First and Last Name (Parent/Guardian #2 if applicable)
Relation
Cell Phone Number
Work Phone Number
Parent's E-mail Address
Highest level of education completed by Parent/Guardian #2
Is your child eligible for the free lunch program at school? *
Number of People Living in House *
What was your household taxable income in 2024? *

Part 4: Parent/Student Consent

CONSENT FOR SERVICES:

I understand pre-college and educational outreach services including but not limited to: academic advising, tutoring referrals, cultural enrichment activities, career and college exploration; will be provided as needed. Services are provided by TRIO & Outreach Programs staff (counselors, volunteers, mentors, tutors and teachers), and are designed to help student's achieve their academic and personal goals. These services are provided free of charge and at the student's will.
ALL INFORMATION RECEIVED WILL BE KEPT CONFIDENTIAL IN COMPLIANCE WITH THE FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT.

 

RELEASE OF INFORMATION:
I authorize TRIO & Outreach Programs staff to access academic and personal information in the legitimate educational interest of my student including but not limited to: public assistance, free & reduced lunch documentation; standardized test scores (State testing scores, SAT, ACT, GED); report cards; unofficial transcripts; official transcripts; attendance records; information about the status of post-secondary education admission/enrollment; financial aid documentation including FAFSA pin code, SAR, and award letters in accordance with The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99). I understand this information is essential in assisting me/my child in preparation for post­secondary education. I further understand all information received is for TRIO & Outreach Programs use only and is held strictly confidential. I intend to give permission for TRIO & Outreach Programs personnel to access and collect this information for the duration of my student's participation in the program and throughout his or her high school and college career; however, if I choose to withdraw this permission, I can call the Program Director at (239) 590-7834 

  

BEHAVIOR AGREEMENT: 

I understand that the rules I am held responsible to at my school campus are the same rules that apply during any event which the TRIO & Outreach Programs. If any rule is broken, I understand if it becomes necessary, the TRIO & Outreach Programs staff will call my parent/guardian and they will be required to pick me up IMMEDIATELY. I also understand that failure to abide by any of the recognized rules may result in my dismissal from the TRIO & Outreach Programs. 

IMAGE (MEDIA) RELEASE (Please read carefully)

I give TRIO & Outreach Programs permission to record my child's participation and appearance in digital or electronic recordings, videotape, audiotape, film, photography, or any other medium to use my child's name, likeness, voice, and biographical information in connection with these recordings. FGCU may make exhibit or distribute all or any part of these recordings for any educational or promotional purpose, which the university deems appropriate. All such recordings shall remain the university's property.
Emergency Contact Name *
Phone Number *

I consent and verify that all the information provided in the application above is true and complete to the best of my knowledge. 
Student Signature *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.
Parent/Guardian Signature *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.