Aaniiih Nakoda College-SSS-Application Form

Our success hinges on the students’ commitment and dedication to their education. Students need to recognize the importance of their education and they must take advantage of every opportunity that Student Support Services Project has designed to ensure their academic success. The Student Support Services Project staff will collectively build the skills and motivation that the student will need to succeed in college.

Accordingly, do you:*

	Yes	No
Agree to participate in the academic, social, mentoring and skill building activities held in conjunction with Student Support Services Project?
Authorize Student Support Services Project to set generally acceptable behavior rules, expectations, and policies; and potentially revoke participation from the Student Support Services Project if you chose not to comply with the rules, expectations, or policies?
Give the Student Support Services Project staff permission to access your academic reports, i.e., grade reports, transcripts, class schedules, and other school records that pertain to Student Support Services Project participation to better assist you?
Agree to release the Student Support Services Project, its employees, instructors, volunteers, and other staff from any claims for injury or damages arising out of your participation?
Certify to the best of my knowledge that the information provided in this application is accurate?
Give permission to use your images in various forms such as photos or videos during any activities of the Student Support Services Project?

I hereby grant permission to ANC Student Support Services to secure the necessary information pertinent to my participation in the SSS Program and ANC (e.g. financial data, standardized test scores, college/high school transcripts, instructor contact, and disability services). Please note that you only need to apply ONCE to be considered for the TRiO SSS Program. I certify the above information to be true to the best of my knowledge.

Student Signature*

Date*

mm-dd-yyyy

All information is confidential. Only aggregate (total/subgroup) data will be used for purposes of federal grand compliance.