Student Support Services

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Student Support Services Request Form

Student Support Services is a federally-funded program sponsored by the Department of Education for students with academic needs. Participants in the program receive academic and personal counseling, tutoring, assistance in transferring to a four-year college or university, equipment and book loans, and workshops on topics such as study skills, time management, and career planning. Students may qualify for the program by meeting certain income guidelines, being a first-generation college student, and/or having a diagnosed and documented disability.

Full Name Student ID #

E-mailAddress

Mailing Address:
Street Address or P.O. Box

City State Zip

Permanent Address:
Street Address or P.O. Box

City State Zip

Telephone:
Home: Alternate:

How did you find out about our program?

ADMISSIONS INFORMATION

Are you currently enrolled at Trident Technical College? Yes No

Term of initial enrollment (ex. Fall 2008)

Field of Study

Working toward Associates degree Certificate Diploma

Do you presently have an Associates or higher level degree? Yes No

TRANSFER INFORMATION

Do you plan to transfer to a 4-year college or university? Yes No Where?

FEDERAL REPORTING/BACKGROUND INFORMATION

Citizenship (Select only one)	Ethnic Background (Select all that apply)
US Citizen	American Indian	Caucasian/White
Territory Resident	Asian/Pacific Islander	Hispanic
Permanent Visa	African American/Black	Other

Date of Birth Gender Female Male

Did either of your parents graduate from a 4-year college or university? Yes No

Do you have a physical or learning disability? Yes No What?

Are you currently registered with TTC's Disability Services office? Yes No

Using the Chart below, do you met the following Federal Income guidelines? Yes No

FEDERAL TRIO PROGRAMS
2008 ANNUAL LOW INCOME LEVELS
Size of Family Unit	48 Contiguous States, D.C., and Outlying Jurisdictions	Alaska	Hawaii
1	$15,600	$19,500	$17,940
2	$21,000	$26,250	$24,150
3	$26,400	$33,000	$30,360
4	$31,800	$39,750	$36,570
5	$37,200	$46,500	$42,780
6	$42,600	$53,250	$48,990
7	$48,000	$60,000	$55,220
8	$53,400	$66,750	$61,410

ADDITIONAL INFORMATION

Which program services are of interest to you? (Please select all that apply)

Academic Counseling	Personal Counseling	Career Counseling
Selecting Courses	Assistance with Financial Aid	Tutoring
Cultural Activities	Transfer Assistance	Preparing a resume
Participating in Futuristic Impact Organization
Other, please list

What unique skills, experiences, and personal attributes can you bring to the Student Support Services program?