Welcome to the TRIO Student Support Services (Classic) application!
Thank you for your interest with the program.

Please complete the application below. 
*Reminder that if you are UNDER 24 years old, you are REQUIRED to provide parent's financial information and signature. 

This application does not allow you to save and go back. You must complete it in its entirety. 
Please contact TRIO staff if you prefer a paper version.

You will need:
- 15 minutes to complete application
- Permanent Resident Card (if applicable)
- Taxable income (Under 24 yrs old, you will need parent's taxable income)
- Signature to submit (Under 24 yrs old, you will need parent's signature)

 
Last Name: *
First Name: *
Middle Name:
Preferred First Name
Are you a U.S, citizen? *
If "No," are you an eligible non-citizen?
If you are an eligible Non-Citizen 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 U.S. citizens or legal residents.
For further information, contact the TRIO Center at 303-914-6764 or stop in to talk with any staff member.

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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 category
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 with RRCC's Accessibility Services office?
Do either of your parents have a 4-year college degree?(Or if you regularly resided with only one parent, did they complete a Bachelor's 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 Associates degree from RRCC? *
If so, what do you plan to study/major in?
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

PLEASE NOTE:  If you are under 24 years of age, you are required to provide information from your parents' tax return (regardless if you live with them or not).
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? *
From the tax form above, what was taxable income on line 15? Enter N/A if no tax return. Enter 0 if earnings not sufficient. *
Below is an example of LINE 15
Example
If no tax return, write a statement that details how you supported yourself last year. Include the source of your support.
Size of Family Unit entered on taxes? *

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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 Coordinator 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. *
How did you hear about TRIO?

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Consenting Agreements
1) I give my permission for the RRCC TRIO staff to access my ACADEMIC, FINANCIAL AID RECORDS, AND IF APPLICABLE VERIFYING REGISTRATION WITH ACCESSIBILITY SERVICES for the purpose of verifying my eligibility for TRIO. 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 are under 24 years of age, your parent must also sign this application!
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 *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.
Parent's signature
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.