Step 4: Student Performance Agreement
Student Performance Agreement
I understand that the Student Support Services program will use the data provided on this form to assist in assessing any academic and/or career planning needs and that all of the information will be kept confidential. I release the following information to the Student Support Services (SSS) staff: high school transcripts, SAT/ACT scores, Northwest graduate reports and instructor evaluations, financial assistance award notices and income information, vocational rehabilitation records and any other information from my academic records pertaining to my enrollment in Student Support Services.
Yes No
The purpose of this agreement is to confirm that student members are aware of the minimum requirements and responsibilities of being in the Student Support Services Program and Summer Bridge Scholars Program. Active membership requires involvement in activities as well as meeting with student and professional staff. Our goal is to have members working towards completing a college degree who are successful academically, mentally and socially. Students enrolled in our program will be enrolled in the program for up to six years or graduation from Northwest Missouri State University, whichever comes first.
Summer Bridge Scholar Commitments
Please read and check the boxes to demonstrate your commitment:
Would you like to be contacted by TRIO staff to make special arrangements (i.e., transportation, early arrival, late departure, dietary needs, bedding rental, or living and learning accommodations during the bridge)?
Special Arrangements Agreement Yes No
I will arrive on July 19, 2022 and stay for the entire TRIO Summer Bridge Scholar program located on the campus of Northwest Missouri State University and participate in all academic, social and scheduled activities.
Attendance Agreement Yes No
I will have no other time commitments, during the TRIO Summer Bridge program. This includes, but is not limited to personal or work commitments, summer programs or tryouts during July 19-21, 2022.
Commitment Agreement Yes No
I will comply with all rules, regulations and policies of Northwest Missouri State University.
Compliance Agreement Yes No
I have completed the 2022-2023 FAFSA.
FAFSA Agreement Yes No
I will enroll in and successfully complete TRIO's course for bridge students during the Fall term.
Course Enrollment Agreement Yes No
I understand that at the completion of the 2022-2023 academic year, I will receive a $1000 scholarship that applies to my 2023-2024 school year, if I meet the following criteria:
I am in academic good standing.
I have met with my academic success coach a minimum of two times each semester.
I have met with my peer mentor a minimum of six times each semester.
I have attended a minimum of three TRIO Student Support Services sponsored events each semester.
I have participated in all Summer Bridge Activities.
Scholarship Agreement Yes No
Student Member Responsibilities
Please read and check the boxes to demonstrate your commitment:
Confidentiality Agreement
Northwest Missouri State University Academic and Professional Waiver
I give my permission to the TRIO and Student Support Services professional staff (SSS assistant director, academic success coach, financial literacy coordinator) to do the following:
I authorize the release of academic, financial and any other information in my SSS files unless and until this authorization is specifically withdrawn in writing by me.
I authorize the release of my records to and from when necessary: parents/guardians, instructors at Northwest, the Office of Equity and Accessibility, Vocational Rehabilitation counselors, Wellness Center and other professional personnel when needed.
I authorize the release of academic records from the Registrar’s Office, Advisement Office, Admissions Office, and the Student Success Center for semester reports that include and are not limited to grade reports, class enrollment, tutoring reports, graduation reports, SAT/ACT Scores, transcripts (high school, other post-secondary institutions, Northwest).
I authorize SSS staff to receive information from and communication with any Northwest departments and other Northwest administrators and on my behalf when the sole purpose is to promote educational opportunities for me.
Academic and Professional Waiver Yes No
Student with Disabilities Waiver
I Waiver Agreement
- Select -
Do
Do not
Does not apply to me
give my permission to the TRIO and Student Support Services professional staff and peer mentor staff to share limited disability-related information about me with my mentor so that they may adequately assist me in my academic progression and success at Northwest Missouri State University.
By submitting this form, I certify that all the information I have typed into this form is correct and I understand that any false information (or omissions) in the contract agreement or its supporting documents will be sufficient grounds for my dismissal in the TRIO Summer Bridge Scholars program. I agree to all the above statements and will fully participate in the TRIO Summer Bridge Scholars program.
To retain a copy of this application for your records, PLEASE PRINT THIS PAGE NOW!
Northwest Missouri State University TRIO SSS Office Administration Building 372 - West Wing 800 University Dr. Maryville, MO 64468
Phone: 660.562.1862 Fax: 660.562.1631 E-mail: ssswebp@nwmissouri.edu