TRiO Summer Bridge Program Application Form

Student Name *

Student address *

City *

State *

ZIP/Postal *

Home phone *

Student cell phone *

Student email *

Choose one

Male
Female
Prefer not to disclose

Prospective Major *

Prospective Minor *

Do either of your parents/legal guardians have a four-year college degree? *

Yes
No

Do you plan to live in the residence hall for Fall? *

Yes
No

Do you plan to participate in athletics at Lourdes? *

Yes
No

If yes, which sport(s)?

Are you a vegetarian? *

Yes
No

Why do you want to participate in the TRiO Summer Bridge Program? *

What are you most excited about with regard to attending Lourdes University? *

What are some of your personal strengths? *

What subjects are your academic strengths? *

With what subjects do you feel you may need assistance? *

What are your academic and/or personal concerns about attending Lourdes University? *

Why should the Student Support Services program select you to participate in the Lourdes University TRiO Summer Bridge Program? Please provide an 100-word response. *

If you have a documented disability, please contact the Office of Accessibility Services at Email or 419-824-3523.

By signing this document, you have agreed to participate, to the best of your ability, in all academic and social activities planned for the TRiO Summer Bridge Program, as well as utilizing the academic and personal support services provided by Student Support Services throughout the year. Please keep in mind that enrollment for the TRiO Summer Bridge Program is limited, so your timeliness is essential.

Name/Signature *

Date *

Email

This field is for validation purposes and should be left unchanged.

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TRiO Summer Bridge Program Application Form