Eastern Maine Community College-SSS-Summer Application

EMCC TRIO Student Support Services - 2023 Summer Success Academic Application (SSA)
The SSA is a free program for qualified students who are new to EMCC. The SSA runs from July 10-28. All students are required to take First-Year Experience, a one-credit course meant to prepare students for college. Students can also take a non-credit Math and/or Writing course to advance out of developmental classes and to sharpen their skills in those areas. Students may commute to EMCC for the SSA each day, or they can live on campus for free. Our program runs from 8:30am-2:30pm Monday-Thursday, with the following daily schedule: Breakfast & Activity 8:30-9:00, First-Year Experience 9:00-10:30, Math 10:30-12:00, Lunch 12:00-1:00, and Writing 1:00-2:30. On Friday July 14th and 21st we will be taking field trips to area cultural sites. Friday, July 28th will be our graduation ceremony and luncheon. All meals, field trip expenses, housing costs, and course supplies are completely free!

To determine eligibility for the TRIO Summer Success Academy (SSA), 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 SSA does not guarantee admittance to TRIO. If you have questions about EMCC's Student Support Services TRIO Program and/or need assistance filling out this application, please contact the TRIO program director, Mike Schwabenbauer, via email at mschwabenbauer@emcc.edu, via phone at 207-974-4642, or in person at 123 Maine Hall.
Student Name*

First NameLast 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@example.com
Personal Email*
example@example.com
Parent/Guardian Email
example@example.com
Personal Information
Gender*

MaleFemalePrefer to self-describePrefer not to say
U.S. Citizen*

YesNoNo, but I am an eligible non-citizen
Ethnicity*

Hispanic/LatinoNot Hispanic/Latino
Race*

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhiteOther
Is English your first language?

YesNo
If no, what is your native language?
Are you a veteran?

Yes (non-active)Yes (active)No
Are you adopted or have you been in foster care?

YesNo
Academic Information
Major / Program of Study at EMCC
Anticipated Fall Enrollment Status

Full-time (12 or more credits per semester)3/4 time (9-11 credits per semester)Part-time (6-8 credits per semester)Less than part-time
Please check the highest educational level that you have achieved

GEDHigh School DiplomaVocational Degree/CertificateSome collegeAssociate's DegreeOther
TRIO participants must be pursuing an associate degree or certificate and planning to graduate from EMCC AND/OR transfer to a four-year college or university after graduating from EMCC.
Occupational / Career goal
What year do you plan to graduate AND/OR transfer from EMCC
Name of college(s) you are interested in attending after graduating from EMCC
Summer Success Academy Information
The SSA is made up of three academic courses: First-Year Experience (FYE), Math, and Writing. Please remember FYE is required. Students can take both Math and Writing, or just one of the two depending on their admissions placement.

First-Year Experience (required)MathWriting
Do you want to live on campus for free during the SSA?

YesNo, I will commute to campus each dayNot sure. Send me more information about housing
What is your admissions status for EMCC?

I have already been accepted for fallI have applied but am still waiting to hear back from admissionsI haven't applied yet
Eligibility Information

Income Information
Have you applied for financial aid (have you completed the FAFSA and put EMCC as a reported school)?

YES. Please initial your permission below to obtain verification from the Financial Aid OfficeNO. (To determine eligibility for program services, you will be asked to provide financial information.)
Initials
For FAFSA purposes, I am considered

DependentIndependent
(Typically, students who are less than 24 years old, unmarried, and have no children are considered dependent.)
Number of family members in your household (including yourself)*
(Family members are those related to you by blood, marriage or law)
Check the amount below which best matches your household’s most recent level of taxable income. (This can be found on line 6 of IRS 1040EZ, line 27 of IRS1040A, or on line 43 of IRS 1040)*

$0-$21,870$21,871-$29,580$29,581-$37,290$37,291-$45,000$45,001-$52,710$52,711-$60,420$60,421-$68,130$68,131-$75,840$75,841+
Family Background
Mother/Guardian 1 Education*

Less than high schoolGEDHigh school gradSome collegeAssociate's DegreeBachelor's DegreeMasters/Ph.D.Unknown
Father/Guardian 2 Education*

Less than high schoolGEDHigh school gradSome collegeAssociate's DegreeBachelor's DegreeMasters/Ph.D.Unknown
Disability: Do you have a documented disability?*

YesNoNot sure
If you answered yes, you must provide documentation to the Coordinator of Accessibility Services to be considered eligible.
ACADEMIC NEED (PLEASE CHECK ALL THAT APPLY)*

I had low grades in high schoolI had low Accuplacer ScoresI have low SAT/ACT scoresI had low scores in another academic proficiency testI have had low grades in college coursesI have a GEDI have experienced failing gradesI have been out of school for 5 or more yearsI have Limited English Proficiency (LEP)I don't know what my educational or career goals areI feel unprepared for college-level courseworkI need help bringing up my grades in required courses for my major
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 may 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, community service projects 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 bi-weekly to develop and follow through with an Academic Support Plan (ASP) 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 authorize EMCC TRIO SSS to obtain, copy, review, and discuss records including high school transcripts, course registration for each semester, enrollment verification, academic progress reports, financial aid records, and standardized test scores. I also 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

EMCC TRIO Student Support Services - 2023 Summer Success Academic Application (SSA)

Contact Information

Personal Information

Academic Information

Summer Success Academy Information

Eligibility Information

Family Background

TRIO Agreement and Application Certification