ECTC SSS 2023-2024 Application

ECTC TRIO Student Support Services

2023-2024 Application
TRIO Student Support Services (SSS) provides program participants with opportunities for academic development, assists with basic college requirements, and motivates participants toward the successful completion of their postsecondary education.

SSS provides the following services to assist the program in meeting its mission and funded objectives: Academic advising, tutoring, financial aid assistance, financial and economic literacy, transfer advising and assistance, transfer and cultural trips, scholarship searches, and academic development programming.

SSS is a federal TRIO Program funded by the U.S. Department of Education at $311,063 per year.
Date*

MonthDayYear
Date
Name*

First NameLast Name
Student ID#*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
KCTCS Email*
example@example.com
Preferred Method of Contact:*

PhoneEmailTextMail
Date of Birth:*

MonthDayYear
Date
Gender*

MaleFemaleNon-binary
Did the parent(s) that you regularly lived with and receive(d) support from earn a Bachelor's Degree (4-year college degree) prior to you turning 18 years old?*

YesNo
Do you have an impairment that limits one or more major life activities (e.g. physical or mental disability, ADHD, ADD, learning disability, chronic condition, mental health diagnosis, etc.)?*

YesNo
If you answered "yes" to the above question, are you registered with ECTC's Office of Student Accessibility?

YesNo
Are you Hispanic or Latino? (Hispanic/Latino refers to a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture origin, regardless of race. If you checked yes, you must also check an associated race.)*

YesNo
Race:*

American Indian/Alaskan NativeAsianBlack/African AmericanWhiteNative Hawaiian/Pacific Islander
Please complete the following information as accurately as possible to determine economic eligibility. All information is kept confidential.
Family Status*

SingleMarriedHead of Household/SingleDependent on Parent Income
Please check the box below which indicates your range of taxable family income last calendar year (to determine your income refer to the "taxable income" line of your federal tax return).*

Less than $21,870$21,871-$29,580$29,581-$37,290$37,291-$45,000$45,001-$52,710$52,711-$60,420$60,421-$68,130$68,131-$75,840more than $75,841
Including yourself, how many people live in your household?*
Please check below if your family was not required to file a federal tax return.

Not required to file.
Did you receive a high school diploma or General Equivalency Diploma (GED)?*

YesNo
If you answered "yes" above, year diploma or GED was received:*
High School GPA
Have you earned a 4-year (Bachelor's) degree or higher?*

YesNo
Please list any prior colleges or vocational institutions you attended. Please include the name of the institution, city, state, and dates of attendance.
Have you participated in a TRIO program before (i.e. Upward Bound, Talent Search, Educational Opportunity Center)?*

YesNo
What degree are you seeking (select one)?*

Associate in ScienceAssociate of ArtsAssociate of Applied Science
What is your area of study (e.g. Business, Biology, Psychology, etc.):
Do you plan to transfer to a 4-year college or university?*

YesNoUnsure
Military Service*

Active Duty MilitarySpouse of Active Duty MilitaryChild of Active Duty MilitaryVeteranNon-Military
Residency Status*

U.S. CitizenU. S. Naturalized CitizenPermanent Resident
If Permanent Resident, please list PR#.
NEEDS ASSESSMENT: Your answers will be used to create a personalized plan of support while with the TRIO Student Support Services (SSS) program. By checking a box below YOU ARE NOT COMMITTING TO ATTEND ONE OF THESE EVENTS. This information will allow the SSS staff to gain a better understanding of your areas of improvement and gain a better understanding of your need for the program. Check all that apply.*

Career CounselingSelecting CoursesInterview TechniquesIncrease GPATest AnxietyFinancial Aid InformationScholarship Search AssistanceTime Management SkillsAcademic CounselingUnderstanding ECTC PoliciesTest Taking SkillsConfidence, Social SkillsObtaining InternshipsFinancial Literacy InformationStudy/Note Taking/Test TakingCritical Thinking SkillsPersonal CounselingPreparing a ResumeTutoringLeadership DevelopmentFAFSA Completion AssistanceEducational GoalsComputer AccessTransfer Counseling
What workshops/seminars would you be interested in attending?*

Stress ManagementTest AnxietyStudy SkillsFinancial AidTransfer InformationTest Taking SkillsTime ManagementBudgeting for CollegeNote Taking SkillsFinancial LiteracyOther
Disclaimer: By signing below, I certify that all the information which I have provided is true and correct to the best of my knowledge. I understand that TRIO Student Support Services (SSS) staff will use the data provided on this application to assist in determining my eligibility for the program. If accepted into the program, I hereby give permission to SSS staff to disclose and receive information concerning the nature of eligibility and information concerning my academic progress, including, but not limited to, grades and transcripts on an as-needed basis with the appropriate faculty and staff at Elizabethtown Community and Technical College. I also give SSS staff permission to view and receive any and all financial aid information from the Financial Aid Office. I give SSS permission to use my name and/or picture to provide recognition in the SSS newsletter, on SSS social media platforms, and in other publications. My signature signifies that I have read and understood this statement and that I am signing free of force or duress.*

I acknowledge I have read the above disclaimer.
Student applicant please type your name.*
Signature of Applicant*

Clear
Time*

:HourMinutesAM/PM Option
Date*

MonthDayYear
Date
Parent/Guardian please type your name (required if student is claimed as dependent).
Signature of Parent or Guardian (ONLY if student is claimed as a dependent)

Clear
Time

:HourMinutesAM/PM Option
Date

MonthDayYear
Date
Should be Empty:

ECTC TRIO Student Support Services

Please complete the following information as accurately as possible to determine economic eligibility. All information is kept confidential.