Coastal Alabama Community College-Bay Minette-SSS

FIRST-TIME APPLICANT
STUDENT INFORMATION FORM

Coastal Alabama Community College’s TRIO Student Support Services program operates in full compliance with eligibility guidelines established by the U.S. Department of Education. To be considered for participation, applicants must submit a complete application along with all required documentation (as applicable). Incomplete applications will not be reviewed. Once your application has been received and reviewed, a message with further instructions will be sent to your Coastal Alabama student email account.
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearmm-dd-yyyy
- A-Number
- 1. Name
  
  First NameLast Name
- 2. Gender
- 3. Date of Birth
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearmm-dd-yyyy
- 4. Current Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip
- Campus Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip
- 5. Home Telephone
  (999)999-9999
- Cell Telephone
  (999)999-9999
- May we text you?
- 6. School Email Address
  example@example.com
- 7. Emergency Contact Name
  
  First NameLast Name
- Emergency Contact Phone Number
  (999)999-9999
- 8. Citizenship Status
  
  Other
- 9. Race/Ethnic Group
- 10. What was your (or your parents') taxable income last year?
- 11. How many people live in the home?
- Which campus do you take most of your classes?
  
  Other
- 12. What is the highest level of education achieved by your parent(s) or guardian(s)? If your parents wers never married to each other, please answer for the parent for whom you actually lived with.
- Mother
- Father
- 12. Did your mother graduate from a 4-year college or university (does she have a bachelor's degree)?
- Did your father graduate from a 4-year college or university (does she have a bachelor's degree)?
- 13. Do you have a physical/learning disability?
- If yes, indicate disability:
- Provide documentation:
  
  Browse Files
  
  Cancelof
- 14. Are you registered with Coastal's ADA office?
- 15. Have you received an Associate's degree (completed two-years of community college)?
- Have you received an Bachelor's degree (completed four-years at a college or university)?
- 16. What obstacle(s) would most likely cause you difficulty in fulfilling your educational goals at Coastal Alabama Community College?
- 17. After graduation, do you plan to transfer to a four-year university?
- 18. Have you ever been a participant in TRiO Student Support Services?
- 19. What do you hope to gain from participating in our Student Support Services Program at Coastal Alabama Community College?
- By signing below, I hereby declare that all of the information on this form is true and complete to the best of my knowledge. I also give the TRIO Student Support Services Director permission to view income information I listed on FAFSA documents.
- Student's Signature
- Date Signed
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearmm-dd-yyyy
- Student Name
  
  First NameLast Name
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearmm-dd-yyyy
- 1. In which of the following areas will you use Student Support Services to assist you?
- 2. What is your major?
- 3. Do you plan to graduate from Coastal Alabama ?
- If yes, approximate year:
- 4. Do you plan to transfer?
- Approximate year:
- 5. Colleges interested in attending:
- 1st choice:
- 2nd choice:
- 6. Have you ever attended any of the following types of programs (check each response that applies)?
  
  Other
- 7. What is the highest academic degree you plan to achieve?
- Student Signature
- Date Signed
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearmm-dd-yyyy
- S.T.A.R AGREEMENT
  (Striving Towards Academic Retention)
  
  As partners in reaching your educational goals, we need to reach a common understanding what you can expect from TRiO Student Support Services (SSS) and what we expect from you.
  
  As a TRiO SSS Program Participant,I am expected to do the following:
  - Attend the following activities:
    o Three Academic Advising/Course Selection Sessions Per Academic Year
    o Two SSS Sponsored Workshops or Seminar Per Semester Term
    o One Financial Aid Counseling Sessions Per Academic Year
    o One Cultural Even Per Academic Year
    o One College Tour Per Academic Year
    o One 4-year University Transfer Assistance Session Per Academic Year
  - Set and reach my academic goals
  - Attend tutoring sessions regularly; especially if you have sigred up for tutoring
  - Attend class regularly, take notes, and keep up with class assignments
  - Maintain Satisfactory Academic Progress (GPA:2.0, Course Completion Rate:67%)
  - Inform SSS staffon any changes in my address or telephone number
  - Consult with SSS staffprior to withdrawing from a course
  - Graduate and transfer to a four-year university within four years
  As a TRiO SSS Program Participant you can expect the staff to do the following:
  - Help you develop realistic, attainable academic goals
  - Monitor your academic progress/needs and provide guidance and recommendations
  - Provide academic advising to assist with course selection
  - Provide 4-year university tansfer assistance sessions
  - Provide learning skills development and academic support as needed and available
  - Provide referrals to other areas for assistance as needed
  - Maintain stict confidentiality of all personal information
  - Be very passionate about your SUCCESS
  - Provide services in a courteous and considerate manner
- I, __________________________ understand that my primary purpose for attending
  
  First NameLast Name
- Coastal Alabama Community College is to earn an Associate's degree and transfer to a 4-year institution.The TRiO Student Support Services staff is committed to assisting me in meeting the requirement necessary for academic progress and achievement each semester. My signature below indicates that I plan to adhere to this contract so that I can attain my educational goals at Coastal Alabama Community College. Violation of this agreement may result in loss of services offered to me by Student Support Services.
- TRiO SSS Program Participant
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearmm-dd-yyyy