TRIO Program Application

1. 1. How did you hear about Student Support Services?
   2. The following information is for statistical purposes only.

      1. Gender

         1. Male
         2. Female
         3. Non-Binary
         4. Other
      2. Pronouns (Optional)

         1. He - Him
         2. She - Her
         3. They - Them
         4. Other
      3. What is your ethnicity?

         1. Hispanic or Latino
         2. Not Hispanic or Latino
      4. What is your race? (Please select all that apply.)

         1. American Indian or Alaskan Native
         2. Asian
         3. Black or African American
         4. White
         5. Native Hawaiian or other Pacific Islander

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.

1. 1. Consent