Owens State Community College-SSS

TRIO STUDENT SUPPORT SERVICES APPLICATION

Per the Family Educational Rights and Privacy Act (FERPA), information in this application is confidential - we will protect your sensitive personal data. All sections of the application MUST be completed.

Incomplete applications may be returned to you or rejected.
Name *

First Name Last Name
OCID
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone
(999)999-9999
DOB *

Month Day Year
Date
Owens Student Email *
example@example.com
In accordance with federal regulations, a student must meet one of the following criteria to be eligible for program services *

A first generation college student(neither parent or guardian has a Bachelor’s degree) Limitedincome (verified by an SSS staff member) Have a documented disability*
*If yes, have you registered with the OCC Disability Resource Center?

Yes No

Academic Information
Major *
Academic Advisor Name

First Name Last Name
High School GPA (if less than 3 years after graduation)
What is your expected year of graduation from Owens?
Type of student *

Full Part-Time
What is your current Owens State Community College academic status? *

New student, regular admission New student, Falcon Express, Rocket Express Transfer student Good standing Warning Probation May Continue (previously dismissed or suspended from Owens)

Needs Assessment Survey
As a student, I want to (Check all that apply) *

Improve general study habits Improve math skills Improve spelling Improve note taking skills Improve vocabulary Reduce math/test anxiety Improve time management skills Improve test taking skills Develop a plan for college courses Increase college reading speed Enhance memory Make good career decisions Improve college reading comprehension Improve grade point average Receive transfer assistance
Please check any of the following items which describe you *

Out of school too long Difficulty meeting deadlines Panic during tests Afraid of failing in college Unsure of college procedures Few computer skills Difficulty finding child care Difficulty participating in discussions Limited experience using Internet Afraid I might not fit in at Owens Difficulty with public speaking Difficulty managing money Difficulty meeting new people Difficulty with organizing/prioritizing May need personal counseling Not prepared for course level Unable to understand course content Conflict with professor Registered for too many classes Changed major one or more times Working too much during week
What obstacle(s) would most likely prevent you from completing your academic goals? (Check all that apply) *

Poor study habits Bad grades Family medical problems Lack of money Take things too seriously Separation or divorce Taking the wrong classes Problems at home No close friends at Owens Always feeling tired Trouble sleeping Easily distracted Recurring health concerns Afraid to speak up in class Too shy Alcohol and/or drug problems Feeling depressed or sad Always worrying No support from family/friends Dealing with bills Test anxiety
My most important areas which I will need assistance are (Check all that apply)
Financial *

Personal Budget FAFSA Grants/Scholarships Loans
Academic *

Course Selection Selecting a Major Practicum
Personal Issues *

Stress Management Substance Abuse Relationships Anxiety Depression Motivation Exploring Diversity Time Management Organization/Prioritization
Transfer to a 4-year institution *

Search Process Application Process Funding Planning Transcripts
Career *

Interviewing Resume/Cover Letter Job Searching Co-op/Internship Leadership Development Goals/Decision-Making

My skills in each of the areas below are (Check the appropriate box) *

Excellent

Above Average

Average

Fair

Poor

Math

Science

Reading

Writing

Study Strategies

Describe a personal strength which you feel will help you be successful as a student. *
After graduation from Owens Community College, I plan to *

Commitments
Note: Applying for this program is a commitment and we expect you to be an active participant while you are a student at Owens Community College.

If you are admitted to Owens Community College TRIO Student Support Services, we will require the following commitment from you:
- I WILL meet with my SSS advisor at least twice a semester.
- I WILL participate in tutoring sessions as needed.
- I WILL participate in SSS financial aid and career development workshops and events.
- I WILL set goals with my SSS advisor that lead to my planned graduation / transfer from Owens Community College.
Completed applications MUST include an active Owens Community College Student email account.

Instructions after submission:
1. A TRIO Student Support Services staff member will contact the applicant within 72 business hours to schedule a virtual intake interview.
  1. Virtual platform will be determined by TRIO SSS staff member.
How did you learn about Owens TRIO Student Support Services?

Owens Staff/Faculty E-Mail Mailing/Flyer Owens Website TRIO Student
If Owens Staff/Faculty or TRIO student, list their name

First Name Last Name
TRIO Student Support Services
30335 Oregon Rd.
College Hall 120
Perrysburg, OH 43551

studentsupportservices@owens.edu
567.661.7300

TRIO SSS aligns with Owens Community College strategic plan Goal 1: Increasing Enrollment, Completion and Student Success, Goal 2: Improve and Enhance the Student Experience, and Goal 5: Improve College Culture and Quality of Life.

Funded by the U.S. Department of Education