Kishwaukee College-SSS-Application Form

  • Kishwaukee College
    TRIO Student Support Services

    Program Application

    • Personal Information 
    • Date of Birth*
       - -
    • Demographic Information 
    • U.S. citizen or permanent resident*
    • Sex*
    • Gender Terms (optional)
    • Preferred Personal Pronouns (optional)
    • Do you identify yourself as (or are you) Hispanic/Latino?*
    • To which racial or ethnic group(s) do you most identify? (check all that apply)*

    • ***All participants will be selected without regard to race, color, creed, national origin, age, gender, religion or sexual orientation***

    • Academic Information 
    • Have you received a high school diploma or high school equivalency certificate?*
    • Do you plan to earn a degree or certificate from Kishwaukee College?*
    • Do you plan to earn an associate degree and transfer to a four-year institution?*
    • Do you currently attend Kishwaukee College?*
    • Are you or will you be a:*
    • What obstacles may affect your academic goals? (check all that apply)*
    • Eligibility Information 
    • Please check the box that describes you (if applicable): The term “first generation college student” means*
    • Have you completed a FAFSA Application for Kishwaukee College?*

    • Independent students are financially separate from their parents and don’t have to provide parent information on the FAFSA.

      Dependent students, for the purposes of filling out the Free Application for Federal Student Aid (FAFSA), is someone who is evaluated for financial aid based both on their own income and their parents’—even if that student’s parents will not contribute financially to their college education.

      Family household size is defined as the total number of people that is in the household and that you or your parents will put on your tax form. This will include you plus any additional family members within the household.

    • Are you currently receiving a Pell Grant?*
    • Do you self-identify as having a documented disability that will impact the learning environment?*
    • If yes, are you currently working with Kishwaukee College’s Disability Services?
    • Services 
    • Check the services you are interested in (check all that apply)*
    • Have you participated in any of the following programs?
    • Consent Statement 

    • By signature, I grant my permission to Kishwaukee College officials to share information regarding my academic record (i.e. admissions information, grades, financial aid, federal tax Information and counseling records) with the Federal TRIO Program.

      I certify all information on this form is true and accurate.

    • Clear
    • Date*
       - -

    • Applications are being submitted to:
      TRIO Student Support Services
      Kishwaukee College
      21193 Malta Road
      Malta, IL 60150
      Phone: 815-825-9304
      Email: triosss@kish.edu

      Student Support Services is a TRIO grant 100% federally funded by the U.S. Department of Education.

    • Submit 
    • Should be Empty: