Community College Of Denver-SSS-Application Form

TRIO Student Support Services – Program Application

Thank you for expressing an interest in participating with the TRIO SSS program at the Community College of Denver. All requested information and questions are necessary to determine eligibility for this federally funded program. SSS Staff will not review incomplete applications; submitting an application does not guarantee your acceptance into the SSS program. Due to the personal nature of some of these questions, your responses will be held in the strictest confidence. Any questions please email the TRIO SSS office at TRIOSSS@ccd.edu or leave a voicemail at 303-352-6425. TRIO SSS will communicate with you via your CCD student email to notify you with any application updates or to request further information.

Tax Return information is required for all students interested in participating with TRIO SSS. Students under 24 years of age, will be required to submit parent(s) tax return information. If you are 24 (and over), your tax information is required. Failure to submit tax information will result in a re-submission of the entire SSS online application. Applications with no tax information are incomplete and will not move forward in the application process.

SELF-ASSESSMENT
SELF-ASSESSMENT

TRIO SSS uses this survey to best serve students. The information is kept strictly confidential. Honest answers help TRIO SSS best meet your needs, but feel free to withhold personal information if you are not comfortable disclosing. There are no right or wrong answers.

42) Self-Assessment: Please identify your current skill level in the following areas using the following scale. (1 = Skill is challenging; 2 = Comfortable with this skill; 3 = One of my best skills)*

	1	2	3
Self-discipline/Focus
Writing skills
Perseverance/Determination
Reading skills
Self-confidence
Study skills
Balancing school-work-life
Library research skills
Managing stress
Note-taking technique
Verbal communication skills
Test-taking strategy
Math skills
Time management

43) TRIO SSS Services: Please identify the most helpful services (Check between three and five services)*

Selecting a majorCourse selectionStudy skills developmentPersonal counselingSelf-confidence buildingUnderstanding the college environmentCareer planningFinancial managementScholarship researchTransfer school preparationFinancial aid advisingAccess to social/cultural activitiesUnderstanding degree requirementTutoringOther
44) Tutoring - Subject(s)
Student Background: Please fill in the blank to each of the questions below.
45) Will you be working while attending college?*
46) If so, how many hours per week?
47) Is English your first language?*

YesNo
48) If no, what is your first language?
49) Have you been out of school for five years or more?*
50) Do you feel comfortable with technology (email, computer)?*
51) Are you a Veteran of the U.S. military?*

YesNo
52) Do you receive any scholarships?*
53) Do you currently have stable housing?*
54) Do you have adequate resources to meet basic needs (food, childcare)?*
55) Are there any other circumstances that effect your education?*

STUDENT ESSAY
STUDENT ESSAY

Student Essay: Please provide a one to two paragraph response to each question below.
1. Why did you choose to go to college, and why did you select CCD in particular?*
2. What are your career and educational goals (be sure to describe your plan and timeline to finish your associate degree)? What do you see yourself doing two-three years from now and after you have completed your Associate’s degree?*
3. What personal or academic challenges must you overcome in order to reach your educational goals?*

RESPONSIBILITY CONTRACT
TRIO Student Support Services — Responsibility Contract
Name*

First NameM.I.Last Name
Student ID Number (S Number)*
Phone Number*
(999)999-9999
Date*

MonthDayYear
mm-dd-yyyy
Email*
example@student.cccs.edu
I understand that I am personally responsible to take initiative for my progress and success TRIO Student Support Services will be there every step of the way to challenge and support me until I graduate from Community College of Denver and transfer to a four-year college or university of choice.

Student Responsibilities
- Meet with your Student Success Specialist and/or Student Ambassador at least three times per semester, either in person, phone, e-mail, text or video chat
- Participate in at least two student activities per semester and complete the SSS Activity Attendance Form
- Update TRIO SSS staff: registration changes, degree changes, semester stop outs, academic transfer, or changes in contact information
  Abide by the CCD Student Code of Conduct
- I understand the terms of this contract and agree to uphold them to the best of my ability. I realize that my failure to meet these student responsibilities may result in probation and dismissal from TRIO SSS.
- I understand that failure to submit required SSS application material (i.e. Application, Student Contract, current Tax Return information) may result in probation or dismissal from TRIO SSS.
Student Success Specialist Responsibilities
- Monitor your academic progress, financial aid status and provide appropriate guidance and intervention
- Provide you with comprehensive guidance including academic, financial aid, financial literacy, career, transfer and personal resources
- Connect you with relevant student activities offered by TRIO SSS and our partner programs around campus
- Provide you exemplary service and accurate information within an inclusive and caring environment
In addition to meeting other academic requirements. I must meet these student responsibilities to be eligible for the TRIO Grant Aid scholarship and other program benefits. Tax Return information is required for all students interested in participating with TRIO SSS. Students under 24 years of age, will be required to submit parent(s) tax return. If you are 24 (or over), your tax information is required. Failure to submit tax information will result in a re-submission of the entire SSS online application. Applications with no tax information are incomplete and will not be reviewed.
Student Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
SSS Staff Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy