Lee College-SSS-Application Form

Are you 24 years of age or older?

YesNo

(If you are under 24 years of age, you will need to attach your parents’ tax return)

Do you have children and/or dependents who receive more than a half of their support from you?

YesNo

Check all forms of financial aid you are receiving:

LoanPell GrantScholarships

Are you married?

YesNo

Total number in household, including yourself:

Have either of your parents or guardians graduated from a four-year college or university?

YesNo

If yes, was it your:

MotherFatherBoth Parents

I certify that the information provided on this application is correct to the best of my knowledge and I give permission to the SSS staff to access my academic, financial, and disabilities information to verify my eligibility for the SSS program. I understand that this information will be kept confidential.

I give the SSS staff permission to discuss my grades, classroom skills/ difficulties with my instructors in order for appropriate tutoring/student support to be arranged. This information may be given to SSS staff in verbal or written form.

I give Student Support Services permission to use my name and/ or picture in Student Support related media releases.

Applicant’s Signature

Date

mm-dd-yyyy

Please upload either:
A copy of your taxes if you are over 24 years old.
A copy of your parents/guardians' taxes if you are under 24 years old.

OR

If you are over 24 years old, a written statement that states your taxable income from the last calendar year signed by you. (If it is not signed, it will not be accepted).
If you are under 24 years old, a written statement that states your parents/guardians' taxable income from the last calendar year signed by them. (If it is not signed, it will not be accepted)

Upload*

1. Why did you choose to attend college?

2. Are you considering transferring to a four-year university? If so, where?

3. Do you plan to complete your associate's degree at Lee College?

4. How many classes do you intend to take each semester?

5. What do you hope to get out of your experience at Lee College?

6. Are you receiving any form of Financial Aid (i.e., scholarships, loans, grants, etc.)?

7. Do you plan to work while attending college? If so, where? How many hours/week?

8. Are you a caretaker for children, a dependent family member, or a friend?

9. How involved is your family in your educational process?

10. What challenges do you think could interfere with your college goals?

11. How do you handle stressful situations?

12. What are your strongest subject areas?

13. How would you describe your learning style?

14. What types of good habits do you plan to use in college? How many hours do you plan to study each week?

15. What type(s) of career(s) are you interested in pursuing?

16. What types of books do you read outside of school?

17. Why do you want to be in TRiO? Why would TRiO be a good fit for you?

18. What are some things you feel you need help with?

What are some things you feel you need help with?

19. Think of a time where you have faced adversity in your life? What helped you overcome that adversity?

20. Being a part of TRiO, we require all participants to be actively engaged in programming such as various academic workshops, cultural events and community service activities. We require students to participate in at least two opportunities a semester. What would be things that might come in the way of your being active in the program?

21. What are your favorite hobbies and pastimes?

Student Requirements:

I agree to maintain a minimum of 17 credit hours per calendar year (fall, spring, and summer). Approval will be needed for less than 12 hours.

Please initial

I agree to make satisfactory progress and maintain a 2.5 GPA each semester and remain in good academic standing with Lee College. If I do not make satisfactory academic progress, I agree to complete a "Probationary Commitment" form with the TRIO/SSS program.

Please initial

I will actively attempt to complete my educational plan and graduate and/or transfer within 8 semesters after being accepted into the TRIO/SSS Program.

Please initial

I agree to meet with the TRIO/SSS Advisor a minimum of three times per semester if GPA is below 2.0 or two times per semester if above 2.0 for academic evaluation, counseling and transfer advising.

Please initial

The first appointment shall be within the first 8 weeks of the semester and the second appointment during the last 8 weeks.
If I am unable to attend my scheduled appointment, I will contact the TRIO/SSS office in advance to reschedule.

I agree to dedicate time to my academic, personal and cultural development by participating in a minimum of two activities each semester with the TRIO/SSS program. Eligible activities include:

Please initial

Tutoring/academic assistance services from the tutoring center or TRIO/SSS
TRIO/SSS workshops
TRIO/SSS cultural activities, service projects, field trips or sponsored events
TRIO/SSS campus visits to colleges and universities

I agree to complete the Free Application for Federal Student Aid (FAFSA) eachyear to maximize my opportunities for financial aid, grant aid and scholarships.

Please initial

I agree to maintain a valid email account and check it regularly. TRIO/SSS will utilize email to send important and time sensitive information regarding services, scholarships, workshops and deadlines.

Please initial

Student Expectations:

1. I will notify my TRIO/SSS Advisor of possible withdrawal or transfer to another
institution, or any change in enrollment status at Lee College BEFORE any decisions are made to ensure that all options have been discussed.
2. I will make an appointment with my TRIO/SSS Advisor or the Program Director upon notification of any probationary or disqualification (academic and/or financial) by Lee College.
3. I will notify the TRIO/SSS office of any phone, address and email changes as soon as they occur.
4. I will seek academic, financial aid and career assistance, and enroll in any skill
building courses or retention programs recommended by my TRIO/SSS Advisor.
5. If I receive tutoring, I will arrive on time and be prepared.
6. I will actively participate in the activities specified by my TRIO/SSS Advisor.
7. I will abide by the Lee College rules and regulations regarding academic honesty and student conduct.
8. I will respect all equipment and property that may be available for my use through the TRIO/SSS Program.

I understand that TRIO/SSS will have access to my academic and personal information through the Lee College integrated database system for monitoring purposes and assessment. I grant permission and authorization for my financial aid and academic records to be released from/to the Financial Aid, DSPS, EOPS, and other programs pertinent to my success at Lee College. I grant permission to TRIO/SSS to use my pictures and comments from TRIO events and activities for program publications and information. I agree to the conditions stated in this contract and that failure to comply with the above requirements and expectations will result in an academic hold being placed on my Lee College account, being placed on probation, or being dismissed from the TRIO/SSS Program.

Name

First NameLast Name

Student ID

Signature

Student Support Services Participant Application