Ashland Community & Technical College-SSS

  • Ashland Community & Technical College
    Program Application

    College Drive Campus
    Room 217 or 218 606.326.2074
    Technology Drive Campus
    Room 157A 606.326.2075

  • Student Support Services is a federal program funded through the U.S. Department of Education. Acceptance into the program is contingent upon meeting eligibility criteria and space availability. Please answer all questions completely. If a question does not apply to you, complete the question by marking “N/A”. All information you supply will be held in strict confidence.

    This application cannot be considered if all information is not included.

    • PERSONAL INFORMATION 
    • Pronouns
    • Date of Birth
       - -
    • Gender
    • Race/Ethnicity
    • Do you have Children?
    • Are you in Ready-to-Work?
    • Are you a Veteran?
    • If yes, did you serve 180 days active duty?
    • Have you ever been in foster care?
    • Are you currently homeless?
    • Citizenship

    • DISABILITY STATUS 
    • Do you have a documented disability?
    • If yes, have you registered with the ACTC Office of Disability Services by submitting documentation of your disability, other than disabled parking tag?
    • Are you currently receiving services from the Office of Vocational Rehabilitation?

    • If you are not currently working with the offices mentioned above, you may be required to submit written documentation by a qualified professional, physician, or state agency to verify your elegibility.

    • EDUCATIONAL INFORMATION 
    • Do you have a high school diploma?
    • If yes: Date of graduation
       - -
    • Do you have a GED?
    • If yes: Date completed
       - -
    • Do you already have a degree (associate's or higher)?
    • Have you attended another college or university prior to ACTC?
    • Are you registered for accommodations with ACTC (with Heather Shelton or Lance Frazier)?
    • Are you enrolled with vocational rehabilitation (Voc Rehab)?
    • Future plans
    • First Generation and Program Needs Information 

    • What is the highest level of education COMPLETED by the parent/guardian(s) who raised you?

    • Mother/Primary Guardian
    • Father/Secondary Guardian
    • TRIO/SSS offers assistance in the following areas. If accepted what services are you most likely to use?
    • Clear
    • Date
       - -
    • SUBMIT 
    • Should be Empty: