Last Name
First Name
Date of Birth
School ID
Social Security Number
Gender
Permanent Address
Permanent City
Permanent State
Permanent Zip
Permanent Phone
Email Address
Institution Entry Grade Level
Race, American Indian or Alaskan Native
Race, Asian
Race, Black or African American
Race, Hawaiian or other Native to Pacific Island
Race, Hispanic
Race, White
Ethnicity
Are you a US Citizen or Permanent Resident
Has either parent completed a four year Bachelor's Degree?
Student Disability
Did you Apply for Financial Aid

I authorize the SSS Program to obtain, copy, review, and discuss records including:

  • High school transcript
  • Course registration for each semester
  • Transcripts from other colleges
  • Academic progress
  • Financial Aid records
  • Final grades and transcripts
  • Standardized test Scores
  • Disability Documentation

 

 

I understand the College reserves the right to admit or deny any student enrollment in the TRiO SSS program. Completion of the application does not guarantee acceptance into the program. I also certify that all of the above information is correct

I understand that if accepted I will be required to attend Orientation and meet with my Academic Coach within the first 30 days.  Inability to participate may lead to dismissal from the program.

Please select a signature verification type.
Referred By