CAPE Network Universal Encouragement Program -- Program Registration

Career and Postsecondary Encouragement Network®

To register your college access program to participate in the CAPE Network® Universal Encouragement Program (UEP), complete and submit the form below. Only registered users are allowed into the Universal Encouragement Program. UEP staff will provide your program contact person with a program identification number that enables use of the Universal Encouragement Program. Each of your participants will enter this number when they respond to the questionnaire. In addition, UEP staff will provide your program contact person with a username and password that will permit your authorized program staff to use the UEP reporting tools.

Official Name of the Program
Program's Street Address
City
State
ZIP Code
Indicate the Type of Program
Please specify an official who will serve as the UEP contact person at the program and authorizes the use of this program. He/She will receive the authorization code, username, and password for administering the program.
Contact Name
Contact Title
Contact Email
Please specify an official who will get the complete set of results.
Name of Official to Receive Results
Email of Official to Receive Results
Please specify a password to be used to retrieve assessment results:
Password
Verify Password
The following questions are about your program:
Number of participants in the program
Approximate number of participants who will participate in the UEP
Grade(s) who will use the UEP (please select all that apply)	6th10th 7th11th 8th12th 9th
Intended use of the form (please select all that apply)	Identify individuals in need of services Support work with parents/guardians in assisting their children Use in program improvement or planning process Identify guidance and programming needs Other (Please specify below)
Geographic classification of the program	Urban Suburban Rural Virtual (Online)

We agree to use this program for the sole use of the program registered on this page (herein referred to as user). As a user, you agree to not share the program with other programs who are not registered. The user also agrees to abide by the Family Educational Rights and Privacy Act (FERPA)and/or any other state law or regulation which protects the privacy of student education records. This includes not releasing information obtained from the CAPE Network Universal Encouragement Program without the expressed written permission from the parent or eligible student to parties other than those expressly permitted by FERPA (overview of the Act can be found at the following web address: http://www.ed.gov/policy/gen/guid/fpco/ferpa/index.html). By submitting this form, the user agrees to abide by the terms set forth in this agreement. Failure to do so may lead to immediate revocation of privileges to use the program.

I agree to the terms described above