Southeast Kentucky Community & Technical-SSS

Student Support Services

Academic Advantage Program

Southeast Kentucky Community & Technical College
700 College Road
Cumberland, KY 40823

Personal Needs
Do you currently have problems maintaining regular housing?

YesNo
In the past year, have you been in foster care?

YesNo
Is English your primary language?

YesNo

Statement of Motivation
Please write a few sentences about what motivated you to attend Southeast AND why you believe the Academic Advantage Program will be helpful to you?

Student Agreements
Confidentiality and Release (required)

In accordance with the Family Educational Rights and Privacy Act (FERPA), I authorize representatives of SKCTC to release my student records to representatives of Academic Advantage (AA), including through the National Student Clearinghouse. This release does not permit AA staff to discuss student academic records with anyone, at any time, other than higher education professionals on a need-to-know basis. I understand that my name may be listed on participant rosters given to college staff and included in program newsletters.
Signature*

Clear
Date

MonthDayYear
mm-dd-yyyy
Liability Release (required)

I indemnify, release, and hold harmless the Kentucky Community and Technical College System, Board of Regents, agents, officers, and/or employees from any and all claims, demands, or causes of action or damage which may accrue on account of bodily or personal injury, property damage, or death suffered by me arising out of my participation in Academic Advantage. I assume any and all risks attendant to my participation.
Signature*

Clear
Date

MonthDayYear
mm-dd-yyyy
Picture/Video Release (optional)

I give permission for my photo/video to be taken in connection with Academic Advantage activities and released for educational and program promotional purposes to newspapers, newsletters, and other media sources, including television. I also give permission to release my name, work product, awards, and honors. If I choose not to be photographed or videoed, it is up to me to step out of group photos/videos.
Signature

Clear
Date

MonthDayYear
mm-dd-yyyy

Participant Contract
By participating in Academic Advantage, you will receive a series of academic, financial, and personal support as well as participate in activities that will increase your chances of graduating and reaching your personal and academic goals. In return, we ask that you make the following commitment to us:
1. I accept responsibility for my own academic success and agree to attend classes regularly. Regular attendance is defined as having no more than 3 unexcused absences in any course during the semester.
2. I agree to devote sufficient time for studying. Sufficient time is determined by studying as long as it takes me to learn whatever it is that I want to learn.
3. I agree to keep appointments with a program staff person or with good reason cancel as early as possible.
4. I agree, if placed on academic warning (making below a C in any class), to participate in weekly academic skills building activities and tutoring sessions.
5. I agree to ask a program staff person for help when needed.
6. I agree to attend 3 advising/coaching sessions (face-to-face, online, phone, or email) per semester.
7. I agree to allow program staff to serve as my assigned advisor as long as I am an active participant in the program.
8. I agree to attend 3 workshops (face-to-face or online) per semester.
9. I agree to try to participate in 1 activity or cultural enrichment trip per year.
10. I agree to maintain a minimum of C average GPA (2.0) each semester.
11. I agree to turn in all required forms to staff and complete all evaluations of program services and staff members.
12. I agree to complete financial aid (FAFSA) forms each year.
13. I agree to check student email weekly.
14. I agree to alert staff when there are changes to name, address, phone, or email.
15. I agree to commit to remain in Academic Advantage through Southeast graduation.
I understand that not following these program requirements could result in my being placed on probation from the program and losing eligibility to receive full program services.
Printed Name*

First NameLast Name
Signature*

Clear
Date

MonthDayYear
mm-dd-yyyy
Please note that you will have to meet with an Academic Advantage staff member to complete the application process. If you are unable to stop by our office, a staff member will be happy to schedule a time via phone or virtually through Microsoft Teams or Facetime.

Comprehensive Needs Assessment
Name*

First NameLast Name
Date

MonthDayYear
mm-dd-yyyy
The needs assessment is designed to help us help you in becoming more prepared for college life and beyond. Please be completely honest, and remember that there are no right or wrong answers. Your answers will be kept confidential.
HOW OFTEN?

Time Management & Organization

	Always	Often	Sometimes	Rarely
Do you write assignment due dates in a planner?
Do you have regularly scheduled study times?
Do you prepare a “to-do” list?
Do you keep track of your grades from tests & assignments?
Do you feel you have enough time to complete your work?

Goal-Setting & Follow Through

	Always	Often	Sometimes	Rarely
Do you set long-term personal goals?
Do you attend classes regularly?
Do you complete and turn in assignments on time?

Study Skills

	Always	Often	Sometimes	Rarely
Do you participate in study groups or study with a partner?
Do you study whether or not you enjoy the subject?
Do you think critically about (analyze & assess) what you learn?
Do you listen in class and participate in discussions/ask questions?

Test-Taking Skills

	Always	Often	Sometimes	Rarely
Do you review past tests, quizzes, or homework when studying for a test?
Do you quiz yourself on new material?
Do you correct and analyze tests after they’re returned?
Do you discuss tests or assignments with instructors?

Reading & Note-Taking Skills

	Always	Often	Sometimes	Rarely
Do you read your textbooks regularly?
Do you take notes on what you read?
Do you separate your notes for each course?
Do you review your notes soon after class?

LEVEL OF NEED?

College

	Strong Need	Some Need	No Need
To learn more about requirements for my major.
To learn more about the transfer process.
To prepare for exams like the ACT, PRAXIS, NCLEX.
To visit more colleges.

Financial Aid

	Strong Need	Some Need	No Need
To learn about college costs and how to pay for college.
To know how to fill out a financial aid form (FAFSA).
To know how to read a financial aid award letter.
To know how and where to get scholarships.

Careers

	Strong Need	Some Need	No Need
To explore careers to help decide what to do for a living.
To learn more about job applications, resumes, and interviews.
To know what an internship is and how to find one.

Life Skills

	Strong Need	Some Need	No Need
To know how to make and stick to a budget.
To know how to manage a checkbook.
To understand how loans (student, personal, mortgage, etc.) work.
To be comfortable speaking and presenting in front of a group.