TRIO Student Support Services SSS Application

To be considered for the Student Support Services Program, you must qualify in one or more of the following categories:

FIRST GENERATION COLLEGE STUDENT:

I attest to the fact that I am a first generation college student. Include your parent's names and the highest grade they completed.

INCOME LEVEL:

The information provided above is true and correct to the best of my knowledge. I attest that the documents I have presented for verification of eligibility are genuine and relate to me. I am aware that any false documents in connection with eligibility will be cause for my dismissal from the Student Support Services Program.

PLEASE COMPLETE QUESTION 3 BELOW IF YOU ANSWERED NO TO QUESTIONS 1 AND 2 ABOVE (YOU DID NOT AND WILL NOT FILE A TAX RETURN THIS CALENDAR YEAR.)

THE STUDENT SUPPORT SERVICES PROGRAM WILL PROVIDE, OR MAKE THE FOLLOWING SERVICES AVAILABLE TO ALL ELIGIBLE PROGRAM PARTICIPANTS:

1. ACADEMIC ADVISEMENT
2. PERSONAL EDUCATION PLAN
3. LEARNING STYLES ASSESSMENT
4. TUTORIAL ASSISTANCE
5. TRANFER ASSISTANCE (VISITS TO 4-YEAR COLLEGES)
6. CAREER COUNSELING
7. DEVELOPMENT WORKSHOPS
8. FINANCIAL AID WORKSHOPS
9. CULTURAL ENRICHMENT ACTIVITIES
10. GRANT AID (MUST SUBMIT SEPARATE APPLICATION)

AS A STUDENT SUPPORT SERVICES PARTICIPANT, I UNDERSTAND AND AGREE TO THE FOLLOWING CONDITIONS IN ORDER TO REMAIN ELIGIBLE FOR SERVICES PROVIDED BY THE PROGRAM:

1. I WILL MAINTAIN AT LEAST 6 CREDIT HOURS WITH A MINIMUM GRADE POINT AVERAGE (GPA) OF 2.0. IF FOR ANY REASON I DROP BELOW 6 CREDIT HOURS, I WILL INFORM THE STUDENT SUPPORT SERVICES OFFICE PRIOR TO DOING SO.
2. I WILL MEET WITH A STUDENT SUPPORT SERVICES COUNSELOR AT LEAST (2) TIMES EACH SEMESTER. THESE SESSIONS WILL BE CONDUCTED TO ENSURE COMPLETION OF MY EDUCATIONAL OBJECTIVES.
3. I WILL COMPLETE A PERSONAL EDUCATION PLAN (PEP) WITH THE STUDENT SUPPORT SERVICES COUNSELOR. I WILL INFORM THE STUDENT SUPPORT SERVICES OFFICE OF ANY CHANGES TO MY EDUCATIONAL PLAN.
4. I WILL INFORM THE STUDENT SUPPORT SERVICES OFFICE BEFORE I WITHDRAW FROM ANY CLASS, OR WITHDRAW FROM THE COLLEGE COMPLETELY..
5. I WILL NOTIFY THE STUDENT SUPPORT SERVICES OFFICE OF ANY CHANGES TO MY NAME, ADDRESS, PHONE NUMBER, OR ANY OTHER PERTINENT DATA RELATIVE TO MY DEMOGRAPHIC, OR CONTACT INFORMATION.
6. I WILL SEEK TUTORING IMMEDIATELY UPON EXPERIENCING ACADEMIC DIFFICULTY IN ANY ENROLLED CURRICULUM CLASS.
7. I WILL PARTICIPATE IN AT LEAST TWO (2) STUDENT SUPPORT SERVICES SPONSORED, OR APPROVED WORKSHOPS, OR ACTIVITIES EACH SEMESTER.
8. I WILL MEET WITH A STUDENT SUPPORT SERVICES COUNSELOR FOR ACADEMIC MONITORING ONCE EACH SEMESTER BY THE 9TH WEEK , OR MIDTERM, OF THE SEMESTER.
9. I UNDERSTAND THAT I MAY APPLY FOR GRANT AID (TRIO SCHOLARSHIP), IF ELIGIBLE, AS LONG AS I MAINTAIN AT LEAST A 2.5 GRADE POINT AVERAGE (GPA), AND MEET THE CRITERIA STATED ON THE STUDENT COMMITMENT CONTRACT. (GRANT-AID IS NOT GUARANTEED)
10. I UNDERSTAND THAT I MUST ATTEND TUTORING SESSIONS IF MY GRADE POINT AVERAGE (GPA) FALLS BELOW A 2.0, OR IF I RECEIVE A LETTER GRADE OF "C" OR LESS ON ANY GRADED ASSIGNMENT. IF I RECEIVE TUTORING ASSISTANCE OUTSIDE OF THE STUDENT SUPPORT SERVICES PROGRAM, I WILL NOTIFY THE PROGRAM OF THESE SESSIONS IN ORDER TO RECEIVE PROGRAM CREDIT FOR DOING SO

FAILURE TO COMPLY WITH THE REQUIREMENTS ABOVE MAY RESULT IN MY DISQUALIFICATION FROM PARTICIPATING IN, OR RECEIVING ASSISTANCE FROM ANY STUDENT SUPPORT SERVICES SPONSORED ACTIVITIES, WORKSHOPS, OR SERVICES.

Information Authorization Release/Confidentiality

By signing this form, I authorize Rockingham Community College or other universities I attended/am attending to release official transcripts, test scores, financial aid award information and other records to the Rockingham Community College Student Support Services Program for educational planning purposes. I also authorize Rockingham Community College Student Support Services Program to release these records to other institutions as they relate to my education planning.

            The personal information that is provided to the Student Support Services Program will be protected under the Family Educational Rights and Privacy Act of 1974. No one will have access to the information unless he or she works with or for the Student Support Services Program or is specifically authorized in question to see the information. The information is necessary to help determine the success of participants in post-secondary education as authorized by the U.S. Department of Education. (20 United States Code 1231a) 

             RCC TRIO Student Support Services Program occasionally publishes student accomplishments and activities in newsletters, social media, and similar publications. By signing below, I acknowledge that my name, image and select information may appear in TRIO SSS publications. 

 

By submitting this form you provide your signature for this application.  Please type your name below: