Central Maine Community College-SSS 1-Application Form

Student Support Services Program Application: 2025-2026
To determine eligibility for the TRIO program, please complete the unshaded sections of this application form. The information you provide is required because CMCC TRIO is a federally funded program and students who wish to participate must meet certain requirements. Any information you provide is strictly confidential. Applying to the TRIO program does not guarantee admittance to the program. If you need help completing this form, TRIO staff are available to help. 207-755-5238
Name

First NameMILast Name
Student ID:
Birthdate:

MonthDayYear
mm-dd-yyyy
Contact Information
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
(999)999-9999
Cell Phone
(999)999-9999
Email (TRIO will use your CM email once you have one)
example@example.com
Personal Information
Gender:
U.S. Citizen:
Place of Birth:
Is English your first language?
If no, what is your native language?
Are you a homeless youth or aging out of foster care?
Eligibility Information
INCOME INFORMATION:
Have you applied for financial aid?
Please initial your permission to obtain verification from the Financial Aid Office
I hereby give consent to the staff of the Office of Student Financial Services at Central Maine Community College to release and discuss program eligibility information including tax return information disclosed under section 6103(l)(13) of title 26 with respect to the applicant and contained in my financial aid, student employment, and student account records, with representatives from CMCC TRIO programs for the purpose of determining eligibility for the TRIO program. The information released may only be used for this specific purpose and no other purpose. I certify that the information reported on this statement is, to the best of my knowledge and belief, true, correct, and complete.
Student Signature

Clear
I attest that the information I have given in this form is true to the best of my knowledge
Today's Date

MonthDayYear
mm-dd-yyyy
DISABILITY
Do you believe you have a documented disability?
If you answered yes, you must provide documentation to the Accessibilities Coordinator to be considered eligible.
Father’s Education

Unknown (explain):
Mother’s Education

Unknown (explain):
Student initials
Academic Information
Major:
Enrollment Status:
1) Have you participated in any other TRIO programs in the past?
2) TRIO participants must be pursuing an associate degree or certificate and planning to graduate from CMCC or transfer to a four-year college or university after graduating from CMCC.
Occupational goal:
What year do you plan to graduate and/or transfer from CMCC?
Names of schools you are interested in attending after graduating from CMCC:
Academic and Soft Skills Needs Assessment
Please check what services you would like to receive from the TRIO Student Support Services Program:
Tutoring (in what class?)
Workshops (check all that apply)
Please check any statement that you agree with:
Student Signature

Clear
I attest that the information I have given in this form is true to the best of my knowledge.
Today’s Date

MonthDayYear
mm-dd-yyyy

Student Support Services Program Application: 2025-2026

Contact Information

Personal Information

Eligibility Information

DISABILITY

Academic Information

Academic and Soft Skills Needs Assessment