TRIO Program Application - Sauk Valley Community College

First Name*

MI

Last Name*

Student ID*Format: @12345678

Street Address

City

State

ZIP

Preferred Phone

I would like to receive text messaging from SVCC TRIO Staff.*

Yes

No

Alternate Phone

Email Address(Must be your SVCC Student Email Address)

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 planning to transfer to a 4-year college.*

Yes

No

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

Yes

No

I have filed or will file for Federal Finanical Aid.*

Yes

No

I have parent(s) that has a degree from a 4-year college.*

Yes

No

I have a documented disability.*

Yes

No

How did you hear about Student Support Services?

The following information is for statistical purposes only.

Gender

Male

Female

Non-Binary

Other

Pronouns (Optional)

He / Him

She / Her

They / Them

Other

What is your Ethnicity?

Hispanic or Latino

Not Hispanic or Latino

What is your Race?

American Indian or Alaskan Native

Asian

Black or African American

White

Native Hawaiian or other Pacific Islander

(Please select all that apply)

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 SVCC 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