Rock Valley College-SSS-Application Form

TRIO Student Support Services Application

The Student Support Services (SSS) Project of Rock Valley College provides eligible students with FREE academic advising; financial aid information; financial literacy awareness; career planning; designated computer lab access (printing services); and tutorial assistance to assist participants in achieving their academic goals. All SSS activities are designed to assist eligible students persistence in college from year to year; remain in good academic standing each semester; and graduate from RVC. Students selected to be SSS Participants must meet certain criteria set forth by the Department of Education. RVC SSS is a 100% federally-funded TRIO program ($261,888 annually for 5 years) under the U.S. Department of Education.

Rock Valley College
Division of Student Affairs
TRIO Student Support Services
3301 N. Mulford Road, Rockford, IL 61114
RockValleyCollege.edu/TRIO (https://www.rockvalleycollege.edu/academics/academic-support-services/trio)
For assistance with the application please call (815) 921-4280
- RVC Student ID*
- Legal Name*
  
  First NameMiddle InitialLast Name
- Preferred Name (If different from Legal First Name)
- How did you hear about TRIO?*
  
  My RVC InstructorA TRIO Staff MemberA TRIO StudentThe websiteA workshop at RVCOther
- My RVC Instructor*
  Instructor Name
- A workshop at RVC*
  Workshop Name
- Student Date of Birth*
  
  MonthDayYear
  mm-dd-yyyy
- Social Security number
  999-99-9999
- Age*
- Gender*
  
  FemaleMaleNon-binary/Prefer not to say
- Last Four of Student's Social Security Number*
- Check One (Due to Federal Regulations, at this time we are only able to accept students who are U.S. Citizens or holders of Permanent Residence Status)*
  
  U.S. CitizenPermanent Resident VisaOther
- Ethnicity/Race (Choose all that apply)*
  
  American Indian/Alaska NativeAsianBlack/African AmericanHispanic/LatinoPacific IslanderWhiteOther
- Ethnicity:*
  
  I am not Hispanic/LatinoI am Hispanic/Latino
- Race:*
  
  American Indian/Alaska NativeAsianBlack/African AmericanWhitePacific IslanderMore than one raceOther
- Are you registered with Rock Valley College's Disability Support Services Office?*
  
  YesNoUnsure
- Would you like more information about Disability Support Services?*
  
  YesNo
- RVC Student Email (s0000000@student.rockvalleycollege.edu (mailto:s0000000@student.rockvalleycollege.edu))*
  example@example.com
- Personal Student Email*
  example@example.com
- Student Phone Number*
  (999)999-9999
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- The financial and non-directory educational record information on your student account is confidential and protected by the Family Educational Rights & Privacy Act (FERPA). FERPA is also known as the Buckley Amendment, Statute 20 U.S.C. 1232 (g), regulations 34 CRF Part 99. We cannot release information to another person without your written
  authorization.
- Have you received your*
  
  High School DiplomaGEDOther
- If you marked other for your High School Diploma/GED, please explain*
- High School GPA at Graduation*
- Month and Year of Graduation or GED Diploma*
- Have you sent your High School transcript to RVC?*
  
  YesNoUnsure
- Have you previously attended college?*
  
  Yes-RVCYes-Another CollegeNo
- College Attended*
- Have you sent your transcripts to RVC?*
  
  YesNoUnsure
- Did you Graduate from this Institution?*
  
  YesNo
- What degree did you earn?*
- Current Grade Classification*
  
  Freshman (less than 30 credits)Sophomore (30 or more credits)Unsure
- What Degree are you seeking?*
  
  Associate of Arts (for Transfer)Associate of Science (for Transfer)Associate of Applied Science (Career)Certificate OnlyUndecidedOther
- Enrollment Status*
  
  Full Time (12 or more credit hours per semester)Part Time (Less than 12 credit hours per semester
- Do you plan to transfer to another school AFTER completing your degree at RVC?*
  
  YesNoI plan on transferring before earning a degree
- ACADEMIC & SUPPORTIVE SERVICES NEEDS ASSESSMENT- Check all areas in which you feel TRIO SSS staff may be able to assist you:*
  
  Academic Coaching — Receive assistance in choosing classes to stay on track to graduate on time.Career Counseling — Receive support in determining the best college major and career for you.Tutoring — Receive personal one-on-one tutoring in select subject areas at no cost to you.Financial Aid and Scholarships — Information and Assistance completing FAFSA and Scholarshipsannually.Financial and Economic Literacy — Learn about managing a budget and making wise financial decisions.Graduation and Enrollment in University — Receive assistance in graduation from RVC and 4-year school enrollment.Learning Styles, Studying, Test-Taking Skills — Assistance in identifying your style of learning and some strategies to study and take tests successfully.Life Skills -- Interpersonal Communication, Written and/or Verbal, Collaborating with Others, Time Management.Technology and Computer Skills -- Navigating Online Environments, Using Technology
- Have you completed a FAFSA?*
  
  YesNoUnsure
- Are you receiving Financial Aid this Semester?*
  
  YesNoUnsure
- Are you at least 24 years of age?*
  
  YesNo
- Are you married?*
  
  YesNo
- Do you have children or other dependents (other than spouse) who receive more than half of your support?*
  
  YesNo
- At any time since reaching age 13, were you an orphan, in foster care or a ward of the court?*
  
  YesNo
- Prior to reaching age 18, were you an emancipated minor or did you have a court-appointed legal guardian?*
  
  YesNo
- Are you homeless (i.e., you lack a fixed, regular, and adequate nighttime residence) or at risk of being homeless?*
  
  YesNo
- NOTE: Taxable Income can be found on the federal income tax return, IRS Form 1040, line 10
  Please bring a copy of your 2023 tax return, a transcript of the return, or a Verification of Non-filing letter from the IRS to the TRIO department on the second floor of the Student Center or email to RVC-TRIO@rockvalleycollege.edu (mailto:RVC-TRIO@rockvalleycollege.edu)
- Name of Parent/Legal Guardian*
  
  First NameLast Name
- Parent Phone Number
  (999)999-9999
- Parent Email
  example@example.com
- Did either of your parents earn a 4-year degree from a college/university?*
  
  YesNoUnsure
- Which parent?*
  
  MotherFatherBoth
- Did either of your parents earn a 4 year degree from a college/university?
  
  Yes- MotherYes- FatherYes- BothNo- NeitherUnsure
- Were you raised by this or both of these parents?*
  
  YesNo
- Which parent were you raised by?
  
  MotherFatherBothNeither
- Number of people living in parent/legal guardian’s household*
- What was parent/legal guardian’s 2023 TAXABLE* INCOME? (This is NOT adjusted gross income and is listed on the 2nd page of most tax forms)*
- NOTE: Taxable Income can be found on the federal income tax return, IRS Form 1040, line 10
  Please bring a copy of your 2023 tax return, a transcript of the return, or a Verification of Non-filing letter from the IRS to the TRIO department on the second floor of the Student Center or email to RVC-TRIO@rockvalleycollege.edu (mailto:RVC-TRIO@rockvalleycollege.edu)
- Did either of your parents earn a 4-year degree from a college/university?*
  
  YesNoUnsure
- Which parent?*
  
  MotherFatherBoth
- Did either of your parents earn a 4 year degree from a college/university?*
  
  Yes- MotherYes- FatherYes- BothNo- NeitherUnsure
- Were you raised by this or both of these parents?*
  
  YesNo
- Which parent were you raised by?
  
  MotherFatherBothNeither
- Number of people living in student’s household*
- What was the student's 2023 TAXABLE* INCOME? (This is NOT adjusted gross income and is listed on the 2nd page of most tax forms)*
- I give RVC TRIO SSS, its representatives and employees, to take photographs/videos of me and my property in connection with all TRIO SSS related activities. I authorize TRIO SSS, its assignees, and transferees to copyright use and publish the same in print and/or electronic media. I agree that TRIO SSS may use such photographs of me with or without my name for lawful purposes, including, but not limited to, publicity, advertising, social media, and web content in connection with TRIO SSS.*
  
  YesNo
- I give the RVC TRIO SSS Program staff permission to obtain any academic or personal information that is necessary for providing assistance to me, evaluating the effectiveness of the program, and fulfilling federal and college reporting requirements. This information may be obtained for college departments/personnel, including, but not limited to: RVC faculty, Services, Dean of Students, Student Life, and peer mentors/tutors.*
  
  YesNo
- I certify that the above information contained on this application is true and complete to the best of my knowledge. I understand that this information will be treated as confidential, but will be reported to the U.S. Department of Education as a condition of funding for this federally funded program. Further, I understand that the Rock Valley College TRIO SSS ACHIEVE AND COMPLETE programs will review my transcript and financial aid information to verify eligibility, determine appropriate services, and track academic progress
- By signing, I attest that all the information on this application is true.*
  
  Clear