Bellingham Technical College-SSS-Application Form

TRIO Student Support Services Application
This program is funded by a US Department of Education grant that requires collecting some demographic information (ethnicity, race, and sex) about the students for whom we provide assistance. The services are free, but we need your cooperation in providing us the following information. Thank you.

STUDENT INFORMATION
Preferred Name
Legal Name*

First NameLast Name
Pronouns

they/themshe/herhe/himOther
Student ID Number*
Date of Birth*

MonthDayYear
mm-dd-yyyy
Age*
Gender*

Non-binaryFemaleMale
Address

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Cell Phone #*
(999)999-9999
Text ok?*

YesNo
Alternate Phone # (optional)
(999)999-9999
Are you a U.S. citizen or permanent resident (green card holder)?*

YesNo
Ethnicity (Please choose one)*

Hispanic/Latino/LatinaNot Hispanic/Latino/Latina
Race (Please choose at least one):*

Black or African-AmericanAmerican Indian/Alaskan NativeAsianCaucasian/WhiteNative Hawaiian/Pacific IslanderOther
The TRIO grant enables us to better support students with disabilities. To ensure we can meet the grant requirement to serve students with disabilities, we ask you to check yes if you have a documented disability (If you check yes, we'll refer you to our Accessibility Resources office for accessibility support.) If you do not have a documented disability, please check no.*

Yes, and I am connected with accessibility servicesYes, but I am not connected with accessibility servicesNo, I do not have a disability.
Are you currently taking classes at BTC?*

YesNo, but I'm starting next quarterNo, but I'm starting later in the year
If yes, we'll refer you to our Accessibility Resources office!
Did any one of your parents receive a bachelor’s degree (4-year college degree)? (If no, congratulations! You’re a first-generation college student!)*

YesNoI don't know
Do you have a high school diploma or GED (or equivalent)?*

YesNo
Have you already completed a college degree (AA, BA, etc.)*

YesNo
What degree are you planning to earn at BTC and what are your career goals?*
Do you plan to transfer to a 4-year college or university?*

YesNo
Have you applied for financial aid (FAFSA)?*

YesNo
In addition to attending college, do/will you work?*

YesNo
Approximately how many hours a week do/will you work?
Are you currently enrolled in any of the following services/programs?*

Accessibility Resources (including L+I students)BFETIMPACT!Running StartSNAP/EBT or TANFWorkFirst or Worker RetrainingVeteran's Services at BTCNone of the above
Support Needs (Check all that apply):

Assistance with navigating collegeFinancial aid helpScholarship searchCareer planning and preparationLeadership & employment opportunitiesCollege student success skillsAssistance in pursuing transfer to 4-year collegeMeeting other students and connecting with campus community
TRIO Tutoring Services (Check all that apply):

1:1 Math tutoring1:1 Writing/English tutoring1:1 Science tutoring1:1 Program-specific tutoring (AutoCAD, nursing, etc.)
Needs Assessment
Academics. Check all that apply to you.

History of failing or withdrawing from coursesLack of academic preparedness for college level courseworkLack of educational and/or career goalsLimited English proficiencyLow college GPALow high school gradesNeed academic support to raise grades in required coursesHave not attended school for 5 years or moreRequired to take pre-college level courses (anything below 100 level)
Tutoring Services. Check all that you are interested in.

Math tutoringWriting/English tutoringScience tutoringProgram-specific tutoring (AutoCAD, nursing, etc.)
Major/Career. Check all that apply to you

Unsure of education, and/or career goalsUnsure of job opportunities, degree requirements, or post-college plansNeed help with transferring & interested in visiting other college campusesNeed support finding an internship related to my field
Financial. Check all that apply to you.

Need help completing the FAFSA/WASFA (applications for government aid)Need help finding or applying to scholarships/grantsNeed help with personal budgetingInterested in exploring student loan optionsInterested in exploring Work Study jobs on campus
Wellbeing. Check all that apply to you.

Feeling overwhelmed or stressed by attending collegeInterested in connecting with BTC free counselingMental, emotional, or physical challenges impacting school or life outside schoolStruggling to balance school, life, work, etc. responsibilitiesPlanning to work 20+ hours/week while in school
Basic Needs. Check all that apply to you.

Unreliable access to a computer or internetNot comfortable using technologyNeed more reliable transportation to come to campusSingle parent in need of childcareExperiencing housing instabilityExperiencing food instabilityInterested in connecting with BTC Basic Needs Navigator
How did you hear about TRIO Student Support Services?

Navigator/AdvisorHigh School CounselorBTC InstructorBTC StudentEmail from TRIO ProgramPhone call from TRIO ProgramWebsiteA TRIO EventFlyerOther
I understand...*

I understand I may be asked to provide copies of tax documents or other income documentation if needed.I authorize the TRIO program at Bellingham Technical College to access my student records, including but not limited to: transcripts, registrations, financial aid records, and test scores.I understand TRIO may need to contact and gather information from college personnel (including Financial Aid, Enrollment, Accessibility Resources, and Advising) on my behalf.I understand that issues discussed between myself and TRIO staff are confidential unless a staff member believes it is necessary to prevent danger to myself or others.I certify all information provided is true and correct to the best of my knowledge.I understand I must schedule and attend an intake appointment with a TRIO staff member for my application to be considered.
Bellingham Technical College does not discriminate on the basis of race, ethnicity, creed, color, sex, gender indentity or expression, citizenship or immigration status, national origin, age, religion, disability, veteran or military status, sexual orientation, genetic information, the presence of any sensory, mental, or physical disability or the use of a trained dog guide or service animal by a person with a disability, pregnancy, marital status, or any other characteristic protected by federal, state, or local law in its programs, activities, and services. The following person has been designated to handle inquries regarding the non-discrimintation policies: Director for Human Resources Allison Mack, 360.752.8354, or hr@btc.edu. For Title IX/Section 504 compliance, contact: Vice President of Student Services Michele Waltz, 360.752.8440, or title9@btc.edu. Mailing address: 3028 Lindbergh Avenue, Bellingham, WA 98225. BTC publications are available in alternate formats upon request by contacting the Accessibility Resources office at 360.752.8576.
Student Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
By signing this application, I attest that I am the individual named above, and I authorize BTC’s Student Success Programs to review my application and college records (i.e. transcripts, financial aid applications and awards, placement scores, etc.) to determine if I am eligible.

Click the Next button below to continue to a short new student survey. This will help us better determine how TRIO can support you!
To what extent do you agree or disagree with the following statements?

Academic Inventory

	Strongly Disagree	Disagree	Neither Agree or Disagree	Agree	Strongly Agree	Not Applicable
I have a clear plan for my educational goal: I know what classes I need to take, which ones to take each quarter, what order I need to take them in, a timeline of how many quarters I need, etc.
I understand the requirements I must meet in order to enter and complete my chosen degree/program (pre-program classes, required grades or GPA, application process, test scores, etc.).
I currently use specific strategies, tools or systems to organize my time and keep track of tasks, deadlines and priorities.
I feel comfortable using computers and navigating technology (e.g., basic computer applications, navigating websites and online programs, researching information on the internet, creating/saving/uploading files, etc.)

Academic Success

	Strongly Disagree	Disagree	Neither Agree or Disagree	Agree	Strongly Agree	Not Applicable
I am aware of the amount of time and effort I will need to commit to college in order to be successful.
I have a strong desire to get good grades.
For the most part, I believe I am in control of whether or not I pass my classes
I already possess many of the skills necessary for college success.

Motivation

	Strongly Disagree	Disagree	Neither Agree or Disagree	Agree	Strongly Agree	Not Applicable
I see significant value in earning a degree.
For the most part, I am good at coping with situations I find frustrating, uncomfortable or stressful.
I feel like college is a place where I belong.

4. When I think about why I am choosing to attend college, the most important things I think about are: (fill in the blank)

Campus Support

	Strongly Disagree	Disagree	Neither Agree or Disagree	Agree	Strongly Agree	Not Applicable
I feel comfortable accessing and navigating BTC’s online resources (website, student email, ctcLink, Canvas, myBTC Portal, etc.).
I know at least one employee at BTC who I feel comfortable going to for questions, guidance or advice.
I am familiar with the roles of different departments that support students such as Registration, Advising, Student Financial Resources, Counseling, Accessibility Resources, Library, Tutoring Center, Veterans Support
I look forward to getting more connected to the BTC community.

Off-Campus Support

	Strongly Disagree	Disagree	Neither Agree or Disagree	Agree	Strongly Agree	Not Applicable
I feel like school fits in with my home life.
I have people in my life who I can talk to about my college experiences.
I know people who I can count on to help me when difficult situations arise.
The people in my household understand what I need to focus on school, study and do homework (e.g., time, quiet, privacy).

Financial Wellness

	Strongly Disagree	Disagree	Neither Agree or Disagree	Agree	Strongly Agree	Not Applicable
I feel confident in my ability to manage my personal financial situation (e.g., budget, expenses, debt, credit).
I understand the costs associated with my degree (e.g., tuition, books, tools, supplies).
I understand how to apply for and access different types of financial aid (e.g., Pell grant, Foundation scholarships, Workforce Funding aid).
I feel comfortable talking about money and financial priorities with at least one person in my life.

Career Confidence

	Strongly Disagree	Disagree	Neither Agree or Disagree	Agree	Strongly Agree	Not Applicable
I chose my degree/program after considering several options and opportunities.
I have a general idea of the skills I need to be successful in the career I am pursuing.
I feel confident about my employability skills, such as networking, finding and applying for jobs, writing my resume and cover letter, interviewing, etc.
I am confident that the pay range for the career I am interested in will be enough to support my/my family’s financial goals.

9. Is there anything else you’d like your TRIO coach to know about you? If so, please include below. (open ended)
Click next to Continue

TRIO Student Support Services Application

Needs Assessment