Coe College-SSS-Application Form

Application for Program Participation
When finished, return to: TRIO Student Support Services, Lower Level, Stewart Memorial Library

The Student Support Services (SSS) Project of Coe College provides eligible students with FREE academic advising, financial aid information, financial literacy awareness, career planning, and tutoring. SSS activities are designed to assist eligible students’ persistence in college from year to year, remain in good academic standing, and graduate from Coe College. Students selected to be SSS Participants
must meet certain criteria set forth by the Department of Education.

Coe College TRIO SSS is a federally-funded program ($352,531.00 annually for 5 years) under the U.S. Department of Education.

PERSONAL INFORMATION
Full Legal Name*

First NameMiddle InitialLast Name
Email*
example@example.com
What do you wish to be called? (If different from legal name)
Coe ID
Sex:*

MaleFemale
Pronouns:
*Gender reporting to the Department of Education is limited to these two options, but the SSS staff acknowledges that there are more identities.
Date of Birth:*

MonthDayYear
Date
Are you a U.S. citizen or permanent resident?*

YesNo
Are you Hispanic or Latino?*

YesNo
Regardless of your answer to the prior question, please indicate how you identify yourself. Check all that apply.*

American Indian or Alaska NativeAsianWhiteBlack or African AmericanNative Hawaiian or Other Pacific Islander
Permanent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
(999)999-9999
Is this your personal cell phone?*

YesNo
Best method of contact:*

TextEmail

EDUCATIONAL & CAREER INFORMATION
Are you a former participant of a TRIO program?*

YesNo
If so, which one

Student Support ServicesTalent SearchMcNairUpward BoundUpward Bound Math/ScienceVeterans’ Upward BoundEducational Opportunity Centers
Classification:*

Freshman (< 8.0 credits)Sophomore (8.0-15.9 credits)Junior (16.0-23.9 credits)Senior (>24.0 credits)
Do you plan to receive your bachelor’s degree at Coe College?*

YesNo
Do you have an intended major?*

YesNo
Comments:
Do you plan to pursue post-graduate work after completing your bachelor’s degree?*

YesNo
My career plans are:*

UndecidedDecided
Please Specify

ELIGIBILITY INFORMATION
Do you have a disability?*

YesNo
If yes, is the disability documentation on file with the Office of Accessibility Services?

YesNo
Do you have a parent/guardian who has completed a bachelor's degree or higher?*

YesNo
Do you consider yourself low-income?*

YesNo
*The term “low-income” means an individual whose family’s taxable
income for the preceding year did not exceed 150% of the poverty
level amount. Please use the chart as a guide. (Income will be
verified by TRIO staff.)

ACADEMIC & SUPPORTIVE SERVICES NEEDS ASSESSMENT
Type a question

Type option 1Type option 2Type option 3Type option 4
What do you consider to be your most pressing academic need?*

Low high school gradesLow admission test scores (ACT, SAT)Low college gradesHigh school equivalencyFailing gradesOut of the academic pipeline for 5 or more yearsLimited English proficiencyLack of educational and/or career goalsLack of academic preparedness for college level courseworkNeed for academic support to raise grades in required courses/academic majorOther
Check all areas in which you feel 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 and Economic Literacy: Learn about managing a budget and making wise financial decisions.Learning Styles and Study/Test Taking Skills: Assistance in identifying your style of learning and some strategies to study and take tests successfully.Graduation & Enrollment in Graduate School: Receive assistance in graduation from Coe & graduate school enrollment.Financial Aid Information & Assistance Applying: Assistance completing FAFSA annually. Learn about scholarships & other financial aid options.
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.

By signing this application, I attest that all the information is true. Moreover, I authorize the release of my academic and financial records to TRIO SSS, understanding that the information on these records will be used only to assess my need for project services, monitor my educational process, and fulfill program reporting requirements.

By signing below, I agree to execute this document electronically and acknowledge that my electronic signature is legally binding and equivalent to a handwritten signature. I also confirm that I have been informed of my right to request a paper copy of this document.
Student’s Signature

Clear
Date

MonthDayYear
Date

Please verify that you are human*
Should be Empty: