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TRIO Student Support Services (SSS) Application

A. Personal Information

Name*
Address*
Include area code
Include area code

I plan to get an associate's degree at Bakersfield College and Transfer to a 4-year college or university (select one):*
Is your career goal to become a teacher?*
What grade level?*

B. Citizenship Status

Student Support Services is a federally funded program which requires all eligible participants to be eligible or Federal Financial Aid (i.e. U.S. Citizen, legal permanent residents, etc.)

Citizenship Status*

C. Academic Need

One of the criteria for admission into TRIO SSS is that participants demonstrate some type of academic need. Please answer all of the following questions to assist us in determining your academic needs. Note that there is no right or wrong answer. Your honesty is important in providing you with the best possible services.

1. Is it difficult for you to take notes in classes?*
2. Do you have a hard time understanding what you read?*
3. Is preparing for and/or studying for tests a challenge?*
4. Is it difficult for you to remember / memorize information?*
5. Do you feel that your writing skills could use improvement?*
6. Is mathematics a difficult subject for you?*
7. Could your computer skills be improved?*
8. Do you feel confident in setting academic and personal goals?*
9. Is it difficult for you to manage your time?*
10. Do you feel anxiety when taking tests?*
11. Do you frequently feel stressed when in a school environment?*
12. Do you feel that your native spoken language may interfere with your ability to success in a university environment?*

D. First Generation Verification

Highest educational level or grade your father and your mother completed: (select one for each parent)

Parent 1 Highest Education Level (Includes parents, step-parents, grandparents, relatives, guardians, or adoptive parents who raised and influenced you for more that 50% of your life before you turned 18.)*
Parent 2 Highest Education Level (Includes parents, step-parents, grandparents, relatives, guardians, or adoptive parents who raised and influenced you for more that 50% of your life before you turned 18.)*

E. Disability Verification

Having a disability, as defined under federal law, is one of the criteria that may make a student eligible to receive TRIO SSS Program services.

Do you believe you may be eligible for the TRIO SSS Program by virtue of disability?*
Have you documented your disability with the Bakersfield College DSPS Office?*

F. Release of Information Waiver

By submitting this form, authorize TRIO Student Support Services (SSS) to gather information concerning my academic progress (standardized test scores, grade point average, earned credits, transcripts, etc.) and financial aid information prior to my participation and throughout my involvement in SSS. I understand that this information is used to assist in the determination of my eligibility for TRIO SSS and it will be strictly confidential. I am aware that my eligibility, participation, and financial aid status will be reported to the U.S. Department of Education in accordance with the grant funding regulations. I certify that the information provided on this application is true and complete to the best of my knowledge. I understand that this is a competitive application process and not all eligible applicants are accepted to the program, and if I am accepted, I must comply with the rules and regulations of the program. I understand that the TRIO SSS staff has the right to dismiss any student whose behavior is incompatible with the goals and standards of the program and the college. I also agree to provide documentation upon request to verify the information reported and I authorize the TRIO SSS Program to verify eligibility requirements with other departments on campus, such as the Financial Aid Office or Disabled Student Services.  I am aware that the personal information that is provided to the TRIO Student Support Services program will be protected under the Family Education Rights Privacy Act of 1974. No one will have access to the information unless they work with or for the TRIO SSS Program, or are specifically authorized by me to see the information. I also agree to allow my name and/or picture to be printed in any TRIO SSS newsletter, publication or display in recognition of academic success, leadership, or graduation, including their website.

This is the parent for students under 18 years of age.
Are you eighteen years of age or older?*
I am the Parent/Guardian and submit this form on behalf of the sudent:*