RAMP Application 2020_21

Reading, Advising, & Mentoring Program (RAMP)

TRIO Student Support Services
Cal Poly Pomona
Application

Information requested is required by the United States Department of Education and will remain confidential. It will be used to determine your eligibility for the program and meet the Department's recordkeeping and reporting requirements.

The option to save and resume this application at a later time is available at the bottom of the form.

Name*

First Name

Initial (optional)

Last Name

Bronco ID*

What was your first term and year @ Cal Poly Pomona?*

First-Generation College Student Status

The Department of Education, in the Higher Education Act of 1965 and 1998, defines the term "first-generation college student" as an individual both of whose parents did not complete a bachelor’s degree; or in the case of students who live with and are supported by only one parent, a student whose only such parent did not complete a bachelor’s degree.

To establish if you are a first-generation college student, please answer the following questions regarding your parents' educational level. If one of your parents did not receive any formal education, use Other for that parent. If you live with and are supported by only one parent, answer Other for the other parent. If you are unsure how to answer the question, email ramp@cpp.edu for guidance.

What is the highest level of education completed by your mother/guardian?*

less than high school some high school high school diploma some college but did not earn a bachelor's degree bachelor's degree or higher

Other:

If you select Other, please explain.

What is the highest level of education completed by your father/guardian?*

less than high school some high school high school diploma some college but did not earn a bachelor's degree bachelor's degree or higher

Other:

If you select Other, please explain.

Financial Aid/Income Status (please complete the RAMP Income Verification Form to determine your low-income status)

Are you receiving financial aid?*

Are you receiving a Pell Grant?*

Have you completed the FAFSA for the current year?*

Disability Status

Are you currently registered with CPP’s Disability Resource Center (DRC)?*

Do we have your permission to confirm your registration with DRC?*

Do you have documentation of a disability?*

Citizenship Status

What is your citizenship status?*

Permanent Resident #*

Ethnicity/Race

Hispanic / Latino?*

Yes No

Please check all that apply:*

American Indian / Alaska Native Asian Black / African-American Native Hawaiian / Other Pacific Islander White Other

Sex*

Male Female Prefer not to state

Date of Birth*

Enrollment Status*

12 or more units (FT) 9-11 units (3/4 time) 6-8 units (1/2 time) Fewer than 6 units

Current Grade Level*

Freshman 1st semester Freshman (0-29 units) Sophomore (30-59 units) Junior (60-89 units) Senior (90 units) Graduate

Current Major*

Campus support programs you are a part of (check all that apply)*

ARCHES BroncoScholars McNair Scholars PolyTransfer Summer Bridge/EOP/RS None

Other:

Degree(s) Completed (check all that apply)

Associate Bachelor’s Other No Degree Completed

How did you hear about RAMP?*

If you have participated in a TRIO program in the past, specify which one and where.*

Trio Program (ie. ETS, Upward Bound, Student Support Services) / Location

Is English your native language?*

How many years have you been speaking your native language and English concurrently?*

Are you considering applying to graduate school for a master’s or doctorate?*

Which graduate program and school?

Graduate Program / School

Permanent Address *

Address Line 1

Address Line 2

City

State

ZIP Code

Is this your preferred mailing address (we will use this address if we need to mail you program materials while providing services remotely)?*

Yes No

Preferred Mailing Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Are you or do you plan on residing on campus?*

Yes No

CPP Email*

Alternate Email*

Phone #*

Emergency Contact Name and Relation*

Emergency Contact Phone #*

Media Release

I, the undersigned, do hereby consent and agree that the Reading, Advising, & Mentoring Program (RAMP) staff and agents have the right to take photographs, videotape, or digital recordings of me, and that my name and identity may be revealed therein, for the purpose of documenting program activities and events.

I release to RAMP staff and agents rights to include such images and recordings, as well as textual information involving my participation in the RAMP program, in program publications, which include printed materials, digital materials and emails, and materials posted to the Web or social networking sites. I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement.

Signature*

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Use your mouse or finger to draw your signature above

Authorization and Affirmation

I hereby authorize RAMP staff to obtain academic, financial aid, and other information pertinent to my participation in RAMP.

I understand that a copy of my application form will be kept on file at the RAMP office and that resulting information received from advisors, admission, financial aid officers, instructors, or other campus staff will be kept confidential in compliance with the Family Educational Rights and Privacy Act.

I affirm to the best of my knowledge that the information I have provided is true.

Signature*

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Use your mouse or finger to draw your signature above

Date*

RAMP is a TRIO SSS retention and graduation program

Email: ramp@cpp.edu
Web: www.cpp.edu/ramp

Phone: (909) 869-4349

Location: Building 15, Room 2919