CHAMPS Student Application - Wayne State University

Complete the application below to apply for CHAMPS services and we will be in touch!

Fields with asterisks (*) are required.

First name *

Last name *

Email *

Date of Birth (xx/xx/xxxx) *

WSU Access ID *

Address *

City *

State *

Zip Code *

Phone Number *

Back-up Phone Number

Name of Emergency Contact *

Relationship to you *

Emergency Contact's Phone Number *

Emergency Contact's Email

Short Answer Questions (to determine the assistance you may need)

Did you spend time in foster care in the State of Michigan? *

Have you applied to Wayne State University and have you received an acceptance letter? *

What type of support would you like from CHAMPS (once accepted to WSU)? *

It can be hard to ask for help. What are some areas you think that you will struggle with? What are some areas that you will do well? *

Is there anything else you want to tell us about yourself? *

Case Worker Information

Case Worker Name

Case Worker Phone Number

I was in foster care in the State of Michigan, on or after my 14th birthday and am currently under the age of 23.

I agree to fully participate in the CHampions Aspiring to Make Pathways to Success (CHAMPS) Program.

I understand that the CHAMPS will contact the Department of Human Service agency or any other relevant agency to verify my eligibility to participate in CHAMPS.

I am aware that all information will be properly preserved and secure in only one location. The information will be used for contact related purposes only; no information will be shared with anyone outside of the program.

I understand that completion of this application does not guarantee admission to WSU or to CHAMPS.

Applicants who are still in high school are strongly encouraged to apply for Tuition Incentive Program before graduation from high school by calling 888.447.2687.

By submitting this application I agree to all of the above. I agree that I will hold WSU harmless as a result of participation in CHAMPS.

Short Answer Questions (to determine the assistance you may need)

Case Worker Information

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