Broward College A. Hugh Adams Central Campus-SSS-ApplicationForm

BROWARD COLLEGE
A. HUGHE ADAMS CENTRAL CAMPUS
TRIO STUDENT SUPPORT SERVICES APPLICATION

Student Support Services (SSS) is a learning community that offers members free comprehensive academic support services to enhance their performance and promote academic success. Our goal is to retain and graduate students who are first generation, low‐income and/or have a disability. SSS is a grant funded program through the U.S. Department of Education.

Eligibility is based on federally defined criteria where at least one of the following must be met:
- A first generation college student (neither parent has a Bachelor’s degree
- Limited income (verified by a SSS staff member) and/or
- Have a documented learning or physical disability
An eligible student must need academic support and be either a US citizen or permanent resident who has not yet earned a bachelor’s degree but is committed to using SSS resources and graduating from Broward College.

WHEN SHOULD I APPLY?

Immediately! Applications are accepted throughout the year, but program size is limited. Please answer all the questions on the application, print clearly in ink. Your responses are necessary to determine program eligibility and will be kept confidential.

If you have questions or need assistance with the application, please email SSS@broward.edu

How can SSS help?
- Advising:
  - Course Selection
  - Registration Assistance
  - Choosing Majors and Careers
  - Developing an Individual Graduation Plan
  - Baccalaureate Transfer Planning
- Financial Assistance:
  - FAFSA Forms
  - Scholarship Search
  - Grant‐Aid
  - Financial Planning
  - Economic Literacy Workshops
- Instruction:
  - Workshops and Classes
  - Tutoring
  - Writing, Math and Reading/Study Skills Assistance
- Resources:
  - Resource room with Computers and Printer Resources

Educational History
What is your high school graduation status?*

Earned High School DiplomaEarned GEDHave not Earned HS Diploma or GED
What year did you earn your Diploma or GED?
If not, What is the highest grade you completed?
Are you a High School graduate?*

YesNo
If yes, what year did you graduate?
If not, highest grade completed?
GED?

YesNo
If yes, year completed
What semester and year did you first enroll at Broward College? (Ex. Spring 2008)
Are you a degree seeker?*
Is this your first time in college?

YesNo

If no, please list any postsecondary institutions attended (other than BC)

	Institution	Location	Dates Attended	Major	Degree (If Completed)
1
2

Current Class Standing

First Year (never attended college before BC-Freshman)First Year (Up to 29 college credits from BC and/or another school-Freshman)Second Year (30-59 college credits from BC and/or another school-Sophomore)I have more than 60 college credits
How many total credits have you completed or earned?

Educational Goals
What is your major/pathway?
What is your major/pathway?
How were you recommended to TRIO SSS Central?*

A Broward College Faculty Member recommended me to TRIO SSS CentralA Broward College Advisor recommended me to TRIO SSS CentralA Broward College Staff member recommended me to TRIO SSS CentralI saw a TRIO SSS Central Flyer/Social Media Post/AdvertisementOther
Please share the name of the Broward College advisor, staff or faculty member that recommended you:
Full Time (12 or more credit hours) or Part Time (Less than 12 credit hours)
What are your educational goals?
What are your future college plans?

Complete my Associate’s Degree Only (2-year Degree)Complete my Associate's Degree and transfer to a 4-year UniversityTransfer to a 4-year University before earning my Associate's degreeComplete a Diploma/Certificate program (Less than 2 years)Continue Taking Credit or Non-Credit Courses as a Non-Degree SeekerUndecided
If transferring to another college, when?
If transferring, what schools?

Enrollment plans for the current academic year

	Nnote whether PT (1-11 cr) or FT (12+ cr) or NE (not enrolling
Fall
Spring
Summer

Personal Concerns (Check your top 5 areas of concern)

Attitude about schoolMotivationAcademic difficultiesTest anxietyMath anxietyGeneral AnxietyLiving situationFamilyFriendsFeeling lonelyLow self-confidenceFeeling angryExtra-curricularSportsSleeping/eating habitsAlcohol/drugsBoyfriend/GirlfriendHealthy choicesOther
Service and Resources
Study Skills

Managing Test AnxietyFocusing/Paying Better AttentionMemory TechniquesNote TakingTime managementOrganization and PlanningTextbook Reading/ComprehensionLearning StylesOther
What would you say is your primary Academic need?*

Failing gradesTest-taking proficiencyLack of Preparedness for College-level courseworkLack of Career/Educational GoalsLow College gradesNeed for Academic Support to Raise Grades in a Required Course(s)Haven’t taken classes for 5 or more YearsOther
I would like SSS to help me with (Check All That Apply):*

Essay writingCareer ExplorationMath AssistanceSetting and Reaching GoalsApplying for ScholarshipsTutoringFinancial Aid AwarenessTransfer PreparationLeadership DevelopmentStandardized Test Taking PrepFocusing/Mental HealthNote-Taking SkillsTime ManagementOrganization & PlanningOther
Tutoring (small group or individual) for which subject(s)?

Affidavit of Truth Statement
I hereby certify that the information provided is true to the best of my knowledge.

I hereby authorize the release of my records in reference to academic transcripts, degree plans, personal assessment scores, financial aid, and any other pertinent information related to my academic endeavors to the Student Support Services staff of Broward College.
We like to recognize student achievements. Do you grant permission to include your name or picture for program related publicity, exhibits or displays? Please indicate preference:*

Permission to print namePermission to print photoNeither Name Nor Photo
Please upload a selfie of you

Browse Files

Cancelof
Student Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Parent/Guardian Signature (required if student is under age 18)

Clear
Date

MonthDayYear
mm-dd-yyyy