Welcome to Northwest Education Access!

We are a nonprofit founded to support students age 16-29 in pursuing education in King and Pierce counties. We support students from earning a GED or high school diploma through taking pre-college courses at community colleges and continuing to college, including Associate’s degrees, Bachelor’s degrees, and certificate programs. To do this, we offer individualized academic advising, career exploration, advocacy, and one-on-one tutoring. 

We help students create a custom education plan catering to their needs and goals, and choose the school and program that is best for them. We also help teach students how to apply for financial aid and scholarships, including our own small scholarship program which you may be eligible for. Funding isn’t guaranteed upon admittance to the program, but we will do our best to find all the resources possible to support you in your education!

Doing the intake helps us run as an organization, and gives us insight on how to support you to the best of our abilities. All information given is confidential. Filling out this intake can take anywhere from 10-15 minutes. If you have any questions, concerns, or need help reach out to your Education Advocate.

PERSONAL INFORMATION

Who is your education advocate?

advocate email

First Name

Last Name

Preferred Name

Date of Birth

STUDENT CONTACT INFORMATION

Cell Phone

Preferred Email

Personal Email

School Email (only answer if applicable)

Preferred form of contact

Is text ok?

We ask this because our organization sometimes sends mass texts to students regarding importatnt information, such as, scholarship information, deadlines, ect

Primary Address Type

Street Address

City

State

Zip Code

County

Preferred Phone

DEMOGRAPHIC INFORMATION

Gender/Gender Identity/Gender Presentation

Other Gender/Gender Identity/Gender Presentaion

Gender Pronoun

Other Gender Pronoun

Sexuality

Other Sexuality

Race, Select all that are true for you.

African, African American, Black

True

Asian, Asian American

True

Latino, Latina, Latinx

True

Multi-Racial

True

Middle Eastern

True

Native American, Alaska Native, Indigenous

True

Native Hawaiian or Pacific Islander

True

White

True

Other Race

True

Other Race defined

Employment Status

Have you ever served on active duty in the US Military?

Are you an immigrant to the US?

Are either of your parents immigrants to the US?

Is English the primary language spoken in your home?

What is the Primary Language spoken in the home?

Other Primary Language

Are you an expecting parent or currently parenting?

HOUSING INFORMATION

What is your current living situation?

Have you ever experienced homelessness

Examples of experiencing homelessness: Staying in a shelter, living on the streets, living in a tent, staying at a motel, "couch surfing" or "doubling up" with friends or family, sleeping in a vehicle, or living in any other unstable or non-permanent situation.

Have you ever been in foster care?

DISABILITY INFORMATION

Our goal is to support you in reaching your education and career goals. We recognize disability as a valued aspect of diversity and strongly believe that access is vital to education. We seek disability information to ensure that we can support you in the most personalized way and will never share this information without your consent.

For this purpose, a disability is defined as something that could:

Impair you body's structure or function including loss of a limb, loss of vision or memory loss, and other physical disabilities
Limit your activity such as difficulty seeing, hearing, walking, or problem-solving
Restrict your participation in daily activities such as working, engaging in social and recreational activities, and obtaining health care and preventative services.

Do you have a disability?

If yes, which of these apply to you most

Physical Disability (Example: loss of limbs, bodily injury, traumatic brain injury, cerebral palsy, vision or hearing impairment, etc)Learning Disability (Example: ADHD, dyslexia, dysgraphia, etc)Neurodivergence/Mental Health Disorder (Example: depression, anxiety, bipolar disorder, Autism Spectrum Disorder, other mental health diagnoses, etc)Other

Other disability

STUDENT EDUCATION INFORMATION

Highest grade level you completed

Year received high school diploma or GED?

Where did you receive it from?

Are you currently enrolled in college?

What college are/were you attending?

Certificate/Degree Earned

FAMILY EDUCATION INFORMATION

Did your parents/guardians graduate high school?

Did your parents/guardians attend college?

INCOME

Number in household

Income Classification

SELECT ANY OF THE FOLLOWING THAT ARE TRUE FOR YOU OR YOUR FAMILY/HOUSEHOLD MEMBERS

Free/Reduced Lunch

True

SNAP (food stamps)

True

SSI/SSDI

True

TANF

True

Unemployment Benefits

True

WIC

True

RELEASE OF INFORMATION

Is there an agency you are working with? If no continue to the next page and if yes fill it out.

I authorize Northwest Education Access to release and receive information regarding my education, employment and case management records with the following agencies.

I understand that my records are protected under Federal and State confidentiality regulations and cannot be disclosed without my written consent unless otherwise provided for in the regulations.

I also understand that I may revoke this consent at any time, except to the extent that action has been taken in the reliance on it. I further acknowledge the information to be released was fully explained to me and that this consent is give to me of my own free will.

Are you working with other agencies?

I authorize the release/receive of confidential information to the following agencies

Yes

Agency 1 - Organization Name

Contact Person Name

Contact Person Phone Number

Agency 2 - Organization Name

Contact Person Name

Contact Person Phone Number

STUDENT & EDUCATION ADVOCATE AGREEMENTS

As your Education Advocate I agree to:

Treat you with respect and patience
Work for and support you and not your school or other institution
Support your personal education goals and in developing a plan to achieve those goals
Go with you to meetings and school offices when you need extra support and if my schedule has capacity
Refer you to community resources when you need support with barriers outside of school
Communicate with you during the working hours of Monday - Friday
Give you the same attention and support as all my other students on my caseload
Not share your personal information with anyone you do not give me permission to share with

STUDENT & EDUCATION ADVOCATE AGREEMENTS

As an Northwest Education Access student, I agree to:

Have respect and patience for my Education Advocate
Communicate with my Education Advocate during working hours Monday-Friday. If I call/text outside those hours, my Education Advocate will get back to me the next working day
Make an appointment with me Education Advocate ahead of time
Communicate with my Education Advocate ahead of time
Be responsible for my personal tasks and work in partnership with my Education Advocate

I agree to the Northwest Education Access student terms

Yes

NWEA STUDENT RIGHTS

Can end support from Northwest Education Access or their Education Advocate at any time

We are here to support you as long as you need

Take a break from Northwest Education Access support or school

We are here to support you if you ever need to take a break and will be here when you want to get started again

Can change your major, pathway, or interest

We are here to support you transfer schools, change your pathways, or if you change your mind about school

Bring up concerns to Education Advocate or Northwest Education Access staff

Are there other agreements you would like to add in our partnership working together?

Signature: Name

Signing your name below means you have read and accept all rights and agreements while you work with NWEA.

THANK YOU!

NWEA

Follow us on Instagram and Facebook!