Recruitment Survey (Application)

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Recruitment Survey (Application)

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DCPS Persists is a free alumni program to help you succeed in college. Through the initiative, DCPS aims to increase college graduation rates of DCPS alumni. Persists hosts events, workshops and checks-in on you during your time in college. For interested students, our program can also match you with a Persists Coach. A coach provides one on one academic, financial and/or personal guidance during your first two years of college.

Enter your Student ID to get started:

Student ID

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**Directions: Please read this form completely, then complete and sign acknowledgments on page 3.**

Student Information

First Name

Middle Name

Last Name

Birthdate

Race/Ethnicity

Preferred Pronouns (update if incorrect)

Gender (please update if incorrect)

High School

Student Address - If address has changed please update.

Mailing Street and Apartment Number

City

State

Postal / Zip Code

Country

Student Contact Details - If contact details have changed please update.

Preferred Method of Contact

Mobile Number

Work Number

Personal Email

College Email

College Plans

Confirm plans after graduation
This program is for students enrolling in a 2-year or 4-year institution.

Are you enrolling in college after graduation?

What colleges did you/have you applied to?

Where are you confirmed to enroll in college this fall?

Funding for College

Have you completed the FAFSA?

Have you completed DCCAP?

Have you completed DCTAG?

Are you receiving support from any of the following? (Choose all that apply)

If other, please describe

Given what you know about DCPS Persists would you like to sign up to participate in the program and receive a DCPS Persists Coach?

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Program Participation

If you have arrived at this point you have confirmed that you would like to enroll in DCPS Persists and opt into receiving the supports from the program.

Confidentiality and Privacy

DCPS will maintain confidentiality of student records in accordance with FERPA and all other applicable federal and local privacy laws. As part of program participation DCPS will have access to the following information:

1. Grades

2. Transcript information

3. Registration and enrollment

4. Financial Aid Information

5. Student Billing

6. Surveys administered by DCPS to students (qualitative data as well)

I acknowledge that I have read and agree to the listed participation agreements required to participate and receive supports from DCPS Persists. (Please Initial)

Voluntary Nature

Participation in the program is voluntary and students may revoke their participation in writing, should they wish to discontinue. Discontinuation of participation will result in ineligibility of DCPS Persists Coaching and grants.
I acknowledge that I have read and agree to the listed participation agreements required to participate and receive supports from DCPS Persists. (Please Initial)

Outcomes are Not Guaranteed
Persists Coaches will work with participating students to help them progress and graduate, but DCPS cannot guarantee any specific outcomes as a result of participating in the program. While DCPS Persists Coaches may liaise with college departments on behalf of participating students, Coaches cannot make decisions on behalf of students. Success and attainment of desired outcomes is ultimately the responsibility of the student.

I acknowledge that I have read and agree to the listed participation agreements required to participate and receive supports from DCPS Persists. (Please Initial)

Please acknowledge you have read each section by typing your initials below.

What does participation look like/responsibilities of the student:

1. Provide DCPS Persists access to your grades, transcript, registration and enrollment records, financial aid information, and student billing information.

2. Participate in surveys administered by DCPS Persists to assess college experience, progress, success, and needs.

3. Meet with DCPS Persists coach to discuss academic performance and overall progress toward college graduation.
Note: Meetings may be virtual.

I acknowledge that I have read and agree to the listed participation agreements required to participate and receive supports from DCPS Persists. (Please Initial).

Please initial below

Confirmation and Acknowledgements

Confirm Persists Participation Interest

Persists will provide alumni coaches to help students enrolling into college through their first 2 years of college. You may be eligible to receive a coaches that will work directly with you to provide academic support; reminders about registration and scholarships; and support on transitioning to college, among other types of resources.

Benefits of Participating

1. Individualized Help - If assigned a coach, your coach will meet with you periodically throughout the semester to discuss strategies for academic success and for utilizing your college’s student support services. Note: Meetings may be virtual. Coaching supports will be available for students’ first two years of college, unless otherwise noted. 2. Targeted reminders regarding scholarships, class registration, financial aid, academic goals, and adjusting to college. Note: Targeted reminders will be available for students’ first two years of college, unless otherwise noted. 3. Updates from the Forever DCPS Alumni email outreach regarding scholarships, college reminders, and other tools for success. 4. Opportunities to connect with DCPS alumni at your college. 5. Communication regarding student support services on college campuses. 6. Financial Supports - Possible eligibility for up to $300 in microgrants per year, for your first two years of college, to help cover unexpected expenses. Note: Funds are limited and you will need to apply to access these funds. Role of DCPS Persists Coaches and Staff Members

1. Meet with you to review and assess the type of supports available to students via the DCPS Persists program. 2. Coordinate opportunities to help you navigate academic, social, financial, and other key challenges in college; and cultivate growth and development among students for self-agency building. 3. Encourage students to take advantage of resources and opportunities that promote persistence to and through college among DCPS Persists students, including academic supports, writing centers, supplemental instruction, and affinity groups. 4. As needed, liaise with key college stakeholders and offices, such as their Office of Enrollment and Office of Student Support, Financial Aid, Advising, Housing, Bursar's Office, among others, in order to promote the retention, progression, and graduation among DCPS Persists students. 5. Send communication, both general and targeted, to DCPS Persists students regarding financial aid, registration, scholarships, adjusting to college, and opportunities to engage with other DCPS alumni, among other components.

We also need your general consent to use electronic records and signatures throughout our relationship with you. So, before you submit this application, you must review and consent to the terms outlined below.

Our Policy

DCPS Persists is committed to a policy of equal treatment for all individuals applying to attend a DCPS Persists program, volunteer, intern, work or otherwise conduct business with our organization. DCPS Persists does not discriminate on the basis of race, color, gender, handicap, age, religion, sexual orientation, or national or ethnic origin.

Acknowledgement

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am into the program, I am granting DCPS Persists permission to contact me. If I decide to unenroll I can do so in writing by emailing my Coach. I understand that there is no cost to me to participate in this program.

Electronic Signature (typing in your name below constitutes an electronic signature):

Full Name

Date Signed

Media Release

I hereby grant permission to DCPS Persists, to use, including to display publicly or to perform, the above-named person's image, likeness, or voice recording on the DCPS Persists website or in any other official DCPS Persists publications without further notice or compensation. I hereby consent that any such image, likeness, or voice contained in photographs, recordings, and tapes are the property of DCPS Persists, which shall have the right to print, reprint, publish, copy, vend, perform or represent publicly, or create derivative works based on and using the image, likeness, or voice depicted in such photograph, film, or sound recording as it may desire free and clear of any claim whatsoever on my part or the part of the above-named person.

I also understand that once the above-named person's image, likeness, or voice recording is published on a website, it can be downloaded by any computer user. Personal information, such as full name, addresses and telephone numbers will never be published. If a person’s name is used with a photograph, film, or sound recording, it will be in the form of a first name and last initial. For example, student Jane Doe may be listed as “Jane D.” Therefore, I agree to indemnify, defend and hold harmless DCPS Persists, its officers, employees, agents, successors and assignees (the “Indemnified Parties”) from and against any and all claims and liabilities resulting from this publishing.

Permission is granted for the use requested above:

Electronic Signature (typing in your name below constitutes an electronic signature):

Full Name

Date Signed

Contact Information