Jefferson Community & Technical College-SSS-Application Form

  • Jefferson TRIO Student Support Services Application

  • TRIO Student Support Services (SSS) at Jefferson Community and Technical College is a federally funded program through the U.S. Department of Education committed to supporting low-income, first-generation college students, and students with disabilities as they work toward completing their academic goals. The program is open to all eligible students regardless of race, color, national origin, sex, disability, or age. Throughout the academic year, participants receive individualized and group academic advising designed to promote academic achievement and support timely degree completion. In addition, TRIO SSS assists students with transfer initiatives, including university exploration, application guidance, and transition planning to four-year institutions. Students also benefit from career counseling, financial literacy education, leadership development opportunities, cultural enrichment activities, and engaging academic and personal development workshops. TRIO SSS fosters a welcoming and supportive learning environment where students are empowered to achieve their educational and career goals. Participation in the TRIO SSS program at Jefferson is provided at no cost to students.

    TRIO Student Support Services Center, Lower Level of Jefferson Educational Center (JEC),
    Office Hours 8:30AM to 4:30PM Monday - Friday

    Director - Joey Decker 502-213-2406 joseph.decker@kctcs.edu 
    Coordinator - Ariana Sheldahl 502-213-2106 ariana.sheldahl@kctcs.edu 
    Coordinator - Ebony Ray 502-213-2106 ebony.ray@kctcs.edu 

  • Personal Information

  • Date of Birth*
     - -
  • Is the Downtown Campus your primary campus?*

  • Federal regulations require that participants qualify in at least one of the following areas:
     
    Low-Income: Student's household meets Federal Income Eligibility Guidelines as verified by Jefferson Community & Technical College
     
    First-Generation: Student reports that neither custodial parent/guardian graduated from a four-year institution 

    Documented Disability: Student has a documented disability and has registered with the Access*Ability Resource Center (ARC).

  • U.S. Citizen*
  • Are you a first-generation college student? (You are a first-generation college student if neither of your parents/guardians received a 4-year, bachelor’s degree)*
  • Do you have a documented disability? (physical, learning, emotional, etc.)*
  • If yes, are you registered with the Access*Ability Resource Center? (ARC)*
  • Are you currently receiving financial aid?*

  • To verify income information, FAFSA documents and information on file with Financial Aid will be reviewed as it relates to the Department of Health and Human Services Poverty Guidelines for TRIO to determine income requirements. You may be contacted and asked to provide additional financial information.

  • Background Information

    The program is open to all eligible students regardless of race, color, national origin, sex, disability, or age.
  • Race*
  • Ethnicity - Hispanic or Latino*

  • Educational Background

  • High School/GED Graduation Date*
     - -
  • Education Status*
  • Do you plan on earning an associate's degree or credential from Jefferson?*
  • Do you plan on transferring to a 4-year institution?*
  • Past TRIO Experience?*

  • Needs Assessment

    Select all that apply
  • Academic- I could use help in the following areas:*
  • Academic Related- I could use help in the following areas:*
  • Career- I could use help in the following areas:*
  • Personal- I could use help in the following areas:*
  • Are you willing to attend regular advising sessions and workshops/seminars?*

  • Dependency Status

  • Marital Status?*
  • Do you have children or dependents (other than a spouse) who receive more than half of their support from you?*
  • At any time since reaching 13 years of age, were you an orphan, in foster care, or ward of the court?*
  • Prior to reaching 18 years of age, were you an emancipated minor or did you have a court appointed legal guardian?*
  • Are you serving on active duty in the Armed Forces?*
  • Are you a US Armed Forces veteran?*
  • Are you homeless or are you at risk of becoming homeless?*

  • Financial Information

  • To verify income information, FAFSA documents and information on file with Financial Aid will be reviewed as it relates to the Department of Health and Human Services Poverty Guidelines for TRIO to determine income requirements. You may be contacted and asked to provide additional financial information.

    *NOTE: Please only include your information if marital status is married, separated, or widowed, if you answered “Yes” to any of the above Dependency questions, or if you are 24 years old or older. Otherwise, please include the income of your parent(s) guardian(s). Taxable income can be found on the Federal Income Tax Return. On IRS form 1040, see line 15.

  • Have you applied for financial aid at Jefferson?
  • Did you file a Federal Income Tax Return for the last calendar year?

  • Confirmation of Application

  • By typing my full name below certifies as my signature and I hereby verify that all the information provided on this application is accurate to the best of my knowledge. I hereby give permission for the Jefferson TRIO Student Support Services program to review any available academic and financial aid records deemed necessary. I understand that this information is confidential and withholding information on this application or giving false information will make my application ineligible for admission to the Jefferson TRIO SSS program.

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  • Today's Date*
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