TRIO Program Application - Sauk Valley Community College

First Name*

Last Name*

Student ID*Format: @12345678

Street Address*

City*

State*

ZIP Code*

Student Email Address *(Must be your 17c起草视频 Student Email Address)

Phone Number*Preferred Phone Number

Alternate Phone

Preferred Method of Contact:*

Phone Number

Email

Text Message

I am currently enrolled at Sauk Valley Community College.*

Yes

No

Major

Program Type

Associate in Arts (AA)

Associate in Science (AS)

Associate in Applied Science (AAS)

Certificate

Please Indicate Yes or No, on the following Questions:

I am a U.S. Citizen or permanent resident.*

Yes

No

I have filed or will file for Federal Financial Aid (FASFA).*

Yes

No

I am an active IMPACT student.

Yes

No

An earned-tuition program for eligible high-school students.

I have a parent with a Bachelor's degree (graduated from a 4-year college).*

Yes

No

I am intend to transfer to a 4-year college.*

Yes

No

I have a documented disability.*

Yes

No

How did you hear about TRIO Student Support Services?Student, Faculty/Staff, Professor, Marketing/Advertisement, Social Media, etc.

Support Needs:

Are you an active military member?

Yes

No

Are you a U.S. Veteran?

Yes

No

Are you experiencing Housing Insecurity?

Yes

No

Are you a former foster youth?

Yes

No

The following information is for statistical purposes only.

Gender*

Male

Female

Other

What is your Race/Ethnicity? *

American Indian or Alaskan Native

Asian

Black or African American

White

Native Hawaiian or other Pacific Islander

Hispanic or Latino

By checking the following box, I give my consent to release the following information to the SSS staff: standardized test scores, semester and mid-semester grades, financial aid records, admission office records, and Academic Advising records. I also give my permission for each of my instructors to submit a written evaluation of my progress to the SSS staff each semester and for SSS staff to communicate with 17c起草视频 professional staff / faculty about me when it pertains to my best interest academically. I understand that all information will remain confidential.

To the best of my knowledge, all information on this form is true and accurate.*

Yes, I Consent