College Assistance Migrant Program Application
The University of Texas Rio Grande Valley
Brownsville, Texas
Section A: Personal Data
o Last Name:
First Name:
Middle:
o
UTRGV ID:
o
Address:
o
Email:
o
Currently Living: [ ]With Parents [ ]With Another Relative [ ]On Own [ ]With Other:
o
Home Number: (___)______________ Cell: (___)_______________
o
My Ethnic Background is: [ ] White (non-Hispanic) [ ] Hispanic/Latino [ ] African American [ ] Other:
o
Father’s Name:
o
Highest Level of Education Completed by Father [Check One]: [] Elementary [] Middle School []High School []College
o
Mother’s Name:
o
Highest Level of Education Completed by Mother [Check One]:[] Elementary [] Middle School []High School []College
o
Parent(s) Martial Status [Check One]: [ ]Married [ ]Divorced/Separated [ ]Single [ ]Widowed
Major:
First UTRGV Semester: [ ] Fall 20___ [ ] Spring 20 __
City:
State:
Zip Code:
Date of Birth:
Current Occupation:
Current Occupation:
Alternate Contact: Complete information below for a person not living at current mailing address
Name:
Relationship:
Address:
Phone: (
)
City:
Cell:
State: _______ ZIP Code:
Section B: Residency Information
o
Are you a U.S. Citizen? [ ] Yes
o
If not a U.S. Citizen, do you hold Permanent Resident status [valid 1-551] for the U.S.?
o
o
[ ] No
If No, country of citizenship: _________________________________
[ ] Yes [ ] No
If Yes, type of Visa: _______________ Date issued: ______________ Visa Number: _________________
If you do not hold a Permanent Resident status, do you hold Temporary Resident status for the U.S.?
o
[ ] Yes [ ] No
If Yes, type of Visa: _______________ Date issued: ______________ Expiration Date: _______________
Section C: High School Information
o
List below the last high schools, colleges/ universities you attended. HS Seniors must submit an official transcript upon graduation.
School
City
State
Attendance Dates
o Class ranking:
out of
GPA (on a 100 Point Scale):
Graduation Plan: [ ]Recommended [ ]Distinguished
o AP Courses Taken:
o Number of College Credit Hours Earned in HS:
STAAR Scores: English Language Arts:
Math:
Science:
Social Studies:
Writing Sub score:
o School Counselor’s Name:
School Counselor’s Phone Number:
Testing Information
Test Name
Exempt, Date Taken or Date To Be Taken
Scores Sent to UTRGV?
Test Scores
Reading:_______ Math:__________
TSI Assessment
Writing:_______ Essay:__________
ACT
English:
Math:
Science Reasoning:
SAT
Comp:
Verbal:
Reading:
Composite:
Math:
CAMP UTRGV - Brownsville Cortez Hall 138 One West University Blvd Brownsville, Tx 78520 Ph: (956) 882-7871 Fax: (956) 882-7876
General Education Diploma (GED)
GED Testing Site and location
Report Date
GED Scores
W/G
SS
Sc
R
M
Total
Academic Activities/Honors/Extracurricular Activities
Mention club participation, volunteer work, etc. Indicate the school years (9th through 12th) during which you were involved.
Activity/Honor/Position
1.
2.
3.
4.
Year Participated, Received or Position Held
9th
10th
11th
12th
Other
Section D: Program Eligibility and Campus Housing
In order to qualify for the services offered by CAMP under the rules of established by the U.S. Department of Education, the student or an
immediate family member must work at least 75 days in the last two years in agriculture as a migrant worker or seasonal/temporary
worker. This includes but not limited to cultivation and harvesting of agricultural products, the production of dairy products [milk],
incubators for poultry and livestock, cultivation of crop pines, fishing in nurseries, plant nurseries and forestation work.
How will you be providing CAMP eligibility verification? [Check One of the Following]:
[ ] A Certificate of Eligibility (COE) [ ] Employer verification letter or statement [ ] Participation (or eligible to participate) in WIA
Campus Housing
CAMP provides up to 20 housing scholarships. The CAMP Housing Scholarship covers the cost of a double room at Casa Bella;
additional fees apply for a single room. Students receive a scholarship for fall and spring semesters on the condition that the student is in
good standing with CAMP. You will be responsible for a $100 deposit and a $50 application fee (see CAMP staff if you have difficulty
paying the deposit or the application fee). Students who receive a housing scholarship will be responsible for following ALL campus
housing rules, attend mandatory evening study hall and sign a CAMP housing contract. CAMP staff is available to provide additional
information or discuss with you and/or your parents about how campus housing works and what to expect if you live on campus.
Are you requesting a CAMP Housing Scholarship to live on campus?
[ ] No If no, skip the next section of the application
[ ] Yes If yes, please provide a short essay on the following:
Describe in detail why you are requesting a housing scholarship & how you think you will adjust to leaving home and living on campus.
Section E: Statement of Understanding and Release of Authorization: I understand that if I am selected, I must participate in ALL
mandatory CAMP activities which include tutoring, mentoring, group & staff meetings and workshops. I agree to keep a minimum 2.0
GPA and earn at least 24 credit hours by the end of the academic year. I understand that failure to comply with CAMP requirements,
regulations and the UTRGV student code of conduct may result in CAMP probation or termination from CAMP. I understand that if I am
on CAMP probation or terminated, CAMP holds the right to reverse any payments made towards dorm fees, book or tuition scholarships.
Release of Authorization: I hereby authorize CAMP staff unlimited access to my academic records in an effort to assist me complete my
first academic year and subsequent years at UTRGV. This authorization constitutes my permission for instructors to release or discuss my
academic performance with UTRGV staff and on CAMP progress reports. I give CAMP staff permission to access my information
through UTRGV Academic Records (or equivalent). I also give CAMP staff permission to publish my name or photographs of me for
CAMP promotional material. I certify that the information provided on my application is true and correct to the best of my knowledge.
Applicant Signature:
Date:
Parent or guardian Signature:
Date:
CAMP UTRGV - Brownsville Cortez Hall 138 One West University Blvd Brownsville, Tx 78520 Ph: (956) 882-7871 Fax: (956) 882-7876
My Migrant Experience
A one-page "My Migrant Experience" essay describing your family and migrant work history. Include your educational goals, career
goals, financial need and why you should be selected to participate in CAMP. You may use this space below to complete your essay.
CAMP UTRGV - Brownsville Cortez Hall 138 One West University Blvd Brownsville, Tx 78520 Ph: (956) 882-7871 Fax: (956) 882-7876
CAMP Application Checklist
Please submit ALL documentation to be considered for CAMP services. Students must be migrant workers (people whose employment
requires travel that prevents them from returning home within the same day) OR seasonal farm workers (people who, within the last 24
months, were engaged in at least 75 days of a farm work and whose primary employment was temporary or on a seasonal basis) OR
they must be an immediate family member of a migrant or seasonal farm worker. The applicant must be a U.S. citizen or have proof of
legal residency. You must have graduated high school (or have a GED), be a first-year college student with less than 24 college credit
hours (post-high school) at the time of application.
Date Completed
General UTRGV Requirements
Apply to UTRGV online at www.applytexas.org (must declare a four-year degree & major)
An Official High School transcript Sealed in an Envelope (a final transcript with all test scores is
required in order to be admitted to UTRGV)
Proof of Bacterial Meningitis Vaccination (see Meningitis Requirement for more information)
Fill out a Free Application for Federal Student Aid (FAFSA) at www.fafsa.ed.gov
Register for and Attend a New Student Orientation (See CAMP Questions for more information)
CAMP Documents
CAMP application (may be submitted in person, emailed or faxed)
High school transcript (a copy of one now with rank & GPA and a final one upon graduation)
A one-page "My Migrant Experience" essay describing your family and migrant work history.
Include your educational goals, career goals, financial need and why you should be selected to
participate in CAMP.
Eligibility Documentation
Certificate of Eligibility (COE)
OR Employer verification letter or statement (on company letterhead)
OR WIA eligibility documentation
2 Letters of recommendation (from a counselor, teacher or an administrator)
Student housing application, if applicable
Acerca de CAMP
El Programa de Asistencia al Migrante (CAMP) es un programa establecido por el gobierno federal, diseñado para estudiantes
universitarios de familias migrantes o de agricultura temporal. Ofrecemos un programa intenso durante el primer año universitario basado
en apoyo personal, académico, y financiero, promoviendo la continuación y graduación del estudiante en la universidad.
Servicios de CAMP: Matriculación en la Universidad de Texas Rio Grande Valley, como un estudiante de primer año los estudiantes
p
del
Actividades de li
Elegibilidad: Estudiantes pueden ser elegibles para participar en CAMP por una de las tres siguientes maneras que incluyen trabajar en
agricultura temporal o migrante.
1. Personas de la familia más cercana o si mismos han trabajado en agricultura temporal o migrante por 75 días durante los últimos 24
meses o trabajo temporal. O trabajaron en: Cualquier actividad relacionada directamente con la producción de cultivos, productos lácteos,
pollos, ganado y la cultivación o cosecha de árboles o cualquiera otra actividad que esté relacionada directamente con granjas de peces.
2. Participación en/o elegibilidad para participar en un programa migrante.
3. Participación en un programa bajo el Acto de Inversiones para Trabajadores, que es proveído para empleados de agricultura migrante y
temporal.
CAMP UTRGV - Brownsville Cortez Hall 138 One West University Blvd Brownsville, Tx 78520 Ph: (956) 882-7871 Fax: (956) 882-7876