• Jackson College TRIO Student Support Services Application

  • TRIO Participation Application

    TRIO Student Support Services (SSS) is a Federal project funded by a grant from the Department of Education with an annual budget of $272,364.00.

    The purpose of TRIO SSS is to support participants in achieving academic success. Students are accepted into the TRIO SSS project based on academic need, eligibility criteria, and space availability. Please fill out the following application completely and accurately. The information you provide is strictly confidential.

    Completion of this application does not guarantee acceptance into TRIO SSS. At this point in time the TRIO SSS project at Jackson College cannot accept JCEC, JPEC or dual enrolled students. If you have any questions please speak to our TRIO Director, Dr. Andrew Winckles (winckleandrew@jccmi.edu).

  • Personal Information

  • 1. How did you hear about TRIO at JC?
  • Race*
  • Ethnicity - Hispanic*
  • Have you participated in a TRIO program before (i.e. Upward Bound, Talent Search, etc.)?*
  • Have you ever been or are you currently in foster care?*
  • Are you currently enrolled in classes?*

  • Eligibility Information

  • Are you a U.S. citizen, or national of the U.S., or do you meet residency for federal student financial aid?*
  • A first generation college student means an individual neither of whose natural or adoptive parents received a baccalaureate (Bachelor's) degree; or a student who, prior to the age of 18,regularly resided with or received support from only one natural or adoptive parent and whose supporting parent did not receive a baccalaureate degree.What is the highest level of education your parent(s) completed*
  • Are you accommodations eligible or do you have a documented disability (IEP, 504, Doctor's Note, etc.)?*
  • Do you already have a college degree or certificate?*
  • Is it your goal to obtain a degree or certificate from Jackson College?*
  • Do you plan to transfer to a 4-year college after receiving a degree or certificate from Jackson College?*
  • Are you currently a dual enrolled high school student?*

  • Intake Information

  • What services interest you?*
  • What are some barriers to your education that you may have anxiety about?*

  • Release of Information:

    As a participant in TRIO SSS, I authorize TRIO staff to keep a file containing my application, intake materials, service records, tutoring records, academic transcripts, and all other documents which might enable the TRIO staff to share and receive information pertinent to my academic progress and participation in the program with Student Services, Center for Student Success, Registration Office, Financial Aid, and any other relevant academic/student affairs department. I permit TRIO staff to inquire about my class attendance, class work, class grades, and I give my instructors permission to release such information to TRIO staff when requested.

    I certify that the information on this application is true and accurate to the best of my knowledge.

  • Date
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    2 digit month, 2 digit day, 4 digit year
    • Submit 
    • Should be Empty: