Joliet Junior College-SSS-2022 Intake Form
Language
  • English (US)
  • Spanish (Latin America)

  • Si desea ver el formulario en español, cambie el idioma en la esquina superior derecha.

  • Center for Multicultural Access & Success

    All information submitted will be secured in compliance with the Family Educational Rights and Privacy Act.
    • Demographic Data 
    • Gender:
    • Race/Ethnicity: (Please check all that apply)
    • Is English your primary language?
    • Residency Status:
    • Educational Information 
    • What are your educational goals? Check all that apply:
    • Program Eligibility 
    • First-Generation Status: Did the parent(s)/guardian(s) you lived with while in high school have a bachelor’s (4 yr college) degree?*
    • Disability Status: Do you have a documented disability?*
    • Will you be receiving services from Disability Services?*

    • Financial Information:

    • For FAFSA purposes, I am considered:*
    • CHOOSE ONE:

    • Income Eligibility

      Income eligibility is based on tax status for the previous year.  If you filed as a dependent your parent/guardian must provide tax information.  The income guideline used to determine eligibility is determined by Federal TRIO income levels (see chart below).

      Family Size Taxable Income Limit
      1 $21,870
      2 $29,580
      3 $37,290
      4 $45,000
      5 $52,710
      6 $60,420
      7 $68,130
      8 $75,840

      For family units with more than eight members, add the following amount for each additional family member: $7,710 for the 48 contiguous states, the District of Columbia and outlying jurisdictions; $9,645 for Alaska; and $8,865 for Hawaii.(Effective as of January 19, 2023)

    • Income
    • CHOOSE ONE
    • Date:*
       - -
    • Date:
       - -

    • Instead of listing this information, you may submit a copy of your signed federal tax forms. This information will be used only to determine and verify eligibility for TRIO. All information is confidential and is never passed on to any other agency. The US Department of Education provides more information about TRIO and eligibility requirements online: https://www2.ed.gov/programs/triostudsupp/eligibility.html

    • Needs & Service Assessment 

    • Check all of the following services that may interest and/or benefit you while attending Joliet Junior College:

    • Would you like a mentor assigned to you?
    • Advising
    • Tutoring
    • Transfer Planning
    • Workshops
    • What obstacles would prevent you from completing your academic goals? Please check all that apply.
    • Do you have children?
    • Personal Statement Questions 

    • Please carefully read and answer the following questions using complete sentences.

    • Certification/Release of Information 

    • I certify that the information I have provided is true and correct to the best of my knowledge. I authorize program staff to receive my transcripts, grades, financial aid data, documentation of a disability, recommendations and evaluations in order to determine eligibility and fulfill the requirements of the TRIO Student Support Services Program at Joliet Junior College.

    • I acknowledge that I have completed all necessary steps in the TRIO SSS application process below:*
    • Further, if admitted to the TRIO SSS program, I agree to the following participation requirements:*
    • Date:*
       - -
    • Photo Release 
    • Periodically, the Center for Multicultural Access & Success Department will use pictures of student participants in printed materials and/or the program’s web page. I understand that such pictures will be used for the purpose of recognizing student accomplishments, documenting program events, and/or publicizing the program. I authorize Joliet Junior College and TRIO Student Support Services to use and reproduce photography(s) of me for these purposes. I further give permission for TRIO Student Support Service to include my name in such publications.*
    • Date:*
       - -
    • Submit 
    • Should be Empty: