Access Plan Eligibility Review

Your Contact Information

First Name

Last Name

Email Address

Office phone number

Are you the primary Search contact?

YesNo

If no, who is the primary Search contact?

Name

Title

Email Address

Office Phone Number

Are you the primary Connections contact?

YesNo

If no, who is the primary Connections contact?

Name

Title

Email Address

Office Phone Number

About Your Organization

Organization Name

Department Name

Organization Website

Your Organization Type

Non-profit College or UniversityNon-profit Scholarship ProviderGovernment agency Other organization (Please note that only Non-Profit Colleges or Universities, Non-Profit Scholarship Providers, and Government Agencies are eligible to use our services)

What types of programs do you intend to communicate to students through your Subscription Plan?

Information about the non-profit college or university, including their academic degree programs Undergraduate admissionsFinancial aid or scholarship opportunitiesGeneral information about accessing higher educationDirect Admissions Other

If Other, please specify

Which of the following does your institution offer? Check all that apply.

Certificates or diplomas Associates degree Bachelor’s degree

My institution is primarily located

In the United States Outside the United States

If other, please specify

Where is your institution located? (Country and city)

Please provide the name(s) of your institution’s accrediting agencies:

Is your institution non-profit, charitable, or fully owned by a government entity?

YesNo

If no, please describe your organization ownership

What is your organization’s Employee Identification Number (EIN)?

Briefly describe your organization’s mission.

Is your organization’s primary activity to award scholarships to students?

YesNo

If no, please explain

Are there any application, membership or other fees required by your organization?

YesNo

If yes, please specify

Please provide the following information for each scholarship offered: name, value, target recipient number awarded annually, and approximate total amount of scholarship dollars awarded each year.

What is your organization’s Employee Identification Number (EIN)?

How does your organization promote access or enhance readiness for postsecondary education?

What is your organization’s funding model for providing program(s)?

What is your organization’s target audience for program(s) offered?

Does your organization partner with an education or government entity?

YesNo

If yes, please provide the partnership name and a brief description of the relationship

Does your organization offer college credit or some other credential to the participants in your program(s)?

Yes, our organization provides college credit for our program(s). Yes, our organization partners with an institution that provides college credit for our program(s). Yes, our organization offers conditional admission to a higher education institution No, our organization does not offer college credit for our program(s). Our organization issues a credential upon completion of the program

Please provide additional details for the option you selected above

Are there any application, membership, program, or other fees required by your organization?

YesNo

If yes, please specify

Does your organization offer aid for those who wish to participate?

YesNo

If yes, please specify

How many students are awarded financial aid annually?

Is there anything else you’d like to share about your organization?

Does your organization use a Customer Relationship Management (CRM) system for outreach for students licensed through Student Search Service?

YesNo

If yes, please specify

If Other, please specify