Thank you for your interest in our Student Support Services program! Please complete this application as thoroughly as possible. You cannot save and restart this application. You may want to review the included items, take some time to make notes and gather the required documents, and then return to submit your application. You must answer all questions with an asterisk*. If you have any questions, please call our office at (303) 914-6764.
Last Name: *
First Name: *
Middle Name:
Are you a U.S, citizen? *
If "No", are you an eligible non-citizen?
If "yes" please provide a copy of Permanent Resident Number and card
If you have one, please upload a copy or photo of your Permanent Resident card
Unfortunately, Federal law does not allow TRIO programs to serve students who are not a citizen or a legal resident. For further resources contact the RRCC Advising office at 303 914 6275 to speak w/an advisor.

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Personal Information

RRCC Student number *
Local Address *
Apt/Suite/Unit
City *
State *
Zip *
Date of Birth: *
Cell Phone (or landline if you do not have a cell). *
School Email Address @student.cccs.edu *
Personal email
Gender *

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Ethnicity

Hispanic/Latino *

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Race

you must answer yes to at least one!

American Indian or Alaskan Native *
Black or African American *
White *
Hawaiian or other Native to Pacific Island *
Asian *

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Eligibility

Do you have any documented physical and/or learning disabilities? *
Is the disability information on file w/RRCC Accessibility Services?
Do either of your parents have a 4-year college degree? *
Highest Educational level of father *
Highest Educational level of mother *

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Academic history

Are you a high school graduate? *
If yes, high school name
If yes, month and year of graduation
If no, have you earned a GED?
If yes, month and year received GED
Have you attended a college other than RRCC? *
If yes, college name
Do you have a prior college degree? *
Have you been out of school for more than 5 years?
Do you plan to earn an Associate's degree from RRCC? *
If yes, what is your major? (write Undecided if not sure)
Do you plan to transfer to a 4-year college/university?
If yes, where?

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Income Verification

Under 24 years old = Dependent

24 years and older = Independent

Did you complete a FAFSA for the current academic year? *
Did you use your parents' taxes or income to complete FAFSA? If yes they must also sign this application). *
Which year is the Form 1040 used to complete your FAFSA? *
Taxable income from Form 1040 selected above. Enter N/A if no tax return. *
If no tax return, write a statement that details how you supported yourself last year. Include the source of your support and the amount of money you earned, if any:
Total number of exemptions or number of people claimed in household from 1040? *
Tax information resource *

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RRCC TRIO Student Support Services Participation Requirements

Please answer Yes to each statement

I will attend the TRIO SSS Kick-Off conference each semester. *
I will attend at least 3 appointments w/my TRIO Navigator each semester. *
I will submit the FAFSA for each year I am enrolled at RRCC. *
I will inform RRCC TRIO staff of any changes to my address or phone number. *
I will complete an Exit Survey w/my TRIO Navigator before leaving the TRIO SSS program. *
I understand that to maintain my TRIO status as an Active Participant I agree to follow through with the above statements to achieve my college success. *

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Consenting Agreements

1. I give my permission for the RRCC TRIO staff to access my academic and financial aid records for the purpose of verifying my eligibility and supporting me academically as a TRIO SSS participant and RRCC student. I understand that the TRIO SSS staff agrees to adhere to all guidelines under FERPA - the Federal Education Rights and Privacy Act. *
2. I give my permission for the RRCC TRIO staff to access my grades electronically for the purpose of supporting me academically at RRCC. I understand that I have access to my academic record at any time. *
3. I understand that services provided by TRIO SSS may be amended or suspended if I violate the RRCC Student Code of Conduct. *
4. I understand that TRIO SSS may photograph, film, or quote TRIO SSS students for the purpose of program outreach. I permit TRIO SSS to use my image and quotes without reimbursement to me, for publication, electronic media, or other appropriate purpose. *
5. I understand that I must meet the eligibility criteria established by TRIO SSS regulations and policies in order to be accepted into the TRIO SSS program. *

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Signatures

Sign and Submit: If you used your parents' taxes to do FAFSA your parent must also sign!
Terms of Submission:
By submitting this application, you acknowledge that all of the above information is correct and accurate to the best of your understanding.
Applicant Signature *
Please select a signature verification type.
Parent's signature
Please select a signature verification type.