Eastern Maine Community College-SSS-Application Form

EMCC TRIO Student Support Services

Program Application: 2024-2025

To determine eligibility for the TRIO program, please complete this application form. The information you provide is required because this is a federally funded program sponsored by the Department of Education and students who wish to participate must meet certain criteria. Any information that you provide is strictly confidential. Please remember that applying to the TRIO program does not guarantee admittance to the program. If you have questions about EMCC’s TRIO Student Support Services program and/or need assistance filling out this application, please contact TRIO Recruitment & Retention Specialist Jodi Renshaw at jrenshaw@mainecc.edu or 207-974-4607.
Student Name*

First NameM.I.Last Name
Preferred Name
Student ID #
Birth Date*

MonthDayYear
mm-dd-yyyy

Contact Information
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone
(999)999-9999
Home Phone (if available)
(999)999-9999
EMCC Email*
example@student.emcc.edu
Personal Email
example@example.com

TRIO Agreement and Application Certification
- I understand that the goal of the TRIO program is to retain and graduate eligible EMCC students. I further understand that being in Student Support Services is a privilege. I understand that:
  1. I will be assigned a TRIO Advisor
  2. I will be assigned a peer mentor
  3. I may receive tutoring, study skills help, academic advising, financial aid assistance, peer support, transfer advising, and other TRIO services while I am an active participant in the program.
- To be considered an active participant, I understand I am required to:
  1. Meet with a TRIO staff member at least twice per semester (academic year only)
  2. Access a minimum of three other TRIO services per semester. These include: tutoring, workshops, college visits, cultural events, and peer mentoring.
- If I fail to meet the requirements for participation, I can be dropped from the program.
- If my GPA drops below a 2.0, I agree to meet with my TRIO advisor to develop and follow through with a Student Success Plan to improve my academic standing.
- I understand that at some time my photograph may be taken, either in a group or individually, by the TRIO program and/or Eastern Maine Community College for promotional purposes without compensation. I give my permission for my photograph to be used for this purpose.
- I understand that spaces in available in TRIO SSS are limited and students will be accepted on a first-come, first-served basis within eligible categories.
- I authorize TRIO staff to contact me via email and text message for important updates and upcoming events.
- I certify that all the information I provided on this application is true and complete to the best of my knowledge.
Student Signature

Clear
Date

MonthDayYear
mm-dd-yyyy
Parent/Guardian Signature (only for financially dependent students)

Clear
Date

MonthDayYear
mm-dd-yyyy

Interest in SSA