ESP Application

The Educational Support Program (ESP) is a federal program funded through a grant from the U.S. Department of Education. Students are accepted to ESP based on academic need, eligibility criteria, and space availability. Your application will be considered based on the information you have written on this application form. Please answer all questions completely.

Personal Information








Ethnic Background:
(select all that apply)









Address and Phone Local Address (if known)







Permanent Address







Phone




Eligibility










Education Information

Have you received your:









Have you participated in any of the following Federal programs: (check all that apply)







What can ESP help you with?

Check all areas in which you feel ESP staff may be able to assist you in the future.










How did you hear about ESP?






Please Read Before Submitting: (you will sign this form during your first meeting in ESP)

By signing below, I agree that I have read and understand the following:

  • I understand that my commitment to ESP is for one year, and that I am expected to meet with my advisor regularly (3 times per semester for sophomores, juniors, and seniors / 4 times per semester for freshmen).
  • I understand that ESP will collect information about my participation in the program for the purposes of developing statistical data, evaluating program efficacy, and assessing my academic and/or career needs.
  • I understand that ESP may use my name and/or picture in promotional materials, including (but not limited to) its monthly newsletter and its website.
  • I understand that information shared with my advisor and/or peer mentor will be kept confidential; furthermore, I understand that such information will not be shared with University faculty/staff members outside of the program without my verbal or written consent, with the following exceptions:
    • Expressed or suspected risk of harm to self
    • Expressed or suspected risk or harm to others
    • Revealed knowledge of the abuse of a minor child
  • I understand that ESP may provide a list of participants to campus departments as deemed beneficial to the service of students enrolled in the program. I understand that I can ask to have my name removed from said list(s) at any time.