Date

MM

DD

YYYY

Name *

First Name

Last Name

Are you a U.S. Citizen (U.S. Born or naturalized) or U.S. National? *

Submit proof per below to info@archsolar.org

Yes

No

Proof of U.S. Citizen or National *

Acceptable forms of proof: -Birth certificate issued by a city, county, or state agency in the United States -Identification page of a valid U.S. passport -Certificate of Citizenship or Naturalization Unacceptable forms of proof: -A permanent resident card -Driver's license -Marriage certificate -Social Security card

Submitted to info@archsolar.org

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you a member of an underserved community? *

Black, Latino, and Indigenous and Native American persons, Asian Americans and Pacific Islanders, and other persons of color.

Yes

No

Are you accepted or enrolled in a Minority Serving Institution (MSI)? *

Yes

No

CRITERIA FOR DISADVANTAGED BACKGROUND STATUS *

Students from a disadvantaged background have either participated in or would have been eligible to participate in Federal Programs such as the Scholarships for Disadvantaged Students, or Loans to Disadvantaged Students. 1. Environmentally Disadvantaged If a student who comes from an environment that has inhibited them from obtaining the knowledge, skills, and abilities to enroll in and/or graduate from an architecture, engineering or construction-related degree is considered as being Environmentally Disadvantaged. The following is a list of common characteristics that describe students who are Environmentally Disadvantaged. The examples are provided as guidance only, and are not intended to be all-inclusive: • Person from high school with low average SAT/ACT scores or below the average State test results. • Person from a school district where 50 percent or less of graduates go to College. • Person who has a diagnosed physical or mental impairment that substantially limits participation in educational experiences. • Person for whom English is not his or her primary language and for whom language is still a barrier to academic performance. • Person who is of the first generation to attend college. • Person from a high school where at least 30 percent of enrolled students are eligible for free or reduced price lunches. – OR – 2. Economically Disadvantaged The following are characteristics that describe students who are considered Economically Disadvantaged: • Students who come from a family with an annual income below a level based on low-income thresholds established by the U.S. Census Bureau, adjusted annually for changes in the Consumer Price Index. • The Secretary defines a ‘‘low income family’’ for various health professions and nursing programs included in Titles III, VII and VIII of the Public Health Service Act as having an annual income that does not exceed 200 percent of the Department’s poverty guidelines. • A family is a group of two or more individuals related by birth, marriage, or adoption who live together or an individual who is not living with any relatives. VERIFICATION Place select the radio button that best matches the Disadvantaged Background status for the student, based on the Criteria for Disadvantaged Background Status described above.

I certify that the student named above is from a disadvantaged background.

I certify that the student named above is NOT from a disadvantaged background.