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TRiO Application

TRiO Application

Please complete the TRiO Student Support Services application form below, or you may choose to print the application form (PDF), which should be returned to the TRiO Office for review.

Please confirm the information you provide is accurate, as it will be used to determine your eligibility for TRiO Support Services, including tutoring, advising, and success coaching.

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Address



Contact Information

Do you text?*
Choose One
Preferred Method of Contact*
Choose One


Emergency Contact Information



Demographic & Eligibility Information

Ethnicity
Gender
Citizenship Status
Are you responsible for your home or children?
Marital Status
Check all that apply


Educational Information

Highest degree of completion
Years you have been at ACC?
Current Enrollment Status



Income Eligibility

You must answer these questions about yourself if you are a financially independent student. Or, if you are under 24 years of age and are a financially dependent student, your parents must answer the following about themselves.
Choose One
Does any of your support come from financial assistance?
Are you a single parent?
Have you lived with your parents in the last year?
How are you paying for your education?
Financial Aid Status
Agencies with whom you are working
Of these other sources of income, indicate any you receive
Employment Status



Family Educational History



Personal and Miscellaneous Information

Do you have any impairment, disability, or other condition which may require services or accommodations that could better your academic success?
Is English your native language?
Do you experience any difficulty speaking, writing, or understanding the English language?
How did you hear about our SSS program?
Check any other Federal Education Programs you have participated in.


Service Request Information

Check the services you may need or want.



Student Responsibility

I understand the information I've shared will help ensure that TRiO-Student Support Services is complying with federal regulations governing funding for this program. I certify that all the information is correct. Further, I give Student Support Services permission to receive copies of my records from the Financial Aid Office and Student Services. I also give this office permission to obtain information regarding my academic progress from faculty.