Application Date *
Last Name *
First Name *
Date of Birth *
School ID *
Gender *
Permanent Address *
Permanent City *
Permanent State *
Permanent Zip *
Permanent Phone *
Email Address *
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 *
How many live in your household? *
What is your parents annual income range? *

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.