Minnesota State Colleges and Universities is committed to a policy of nondiscrimination in employment and education opportunity. No person shall be discriminated against
in the terms and conditions of employment, personnel practices, or access to and participation in, programs, services, and activities with regard to race, sex, color, creed,
religion, age, national origin, disability, marital status, status with regard to public assistance, sexual orientation, or membership or activity in a local commission as defined by
law.
This publication can be made available in an alternative format to individuals with disabilities by calling 651-779-3354, TTY 651-773-1715,
or through the Minnesota Relay Service at 1-800-627-3529
STUDENT EDUCATIONAL HISTORY
Do you plan to be enrolled full-time or part-time? □ Full-time □ Part-time
Do you plan to receive a degree from Century College? □ Yes □ No
If yes, what degree? _____________________________________________
Do you plan to transfer to a four year college/university?
□ Yes □ No
If yes, for what program? __________________________________________
How can we help you complete your goals? (check all that apply)
APPLICANT’S PERSONAL STATEMENT (please address the following points)
Briefly explain your educational and career goals.
What help might you need to complete your goals?
STUDENT CERTIFICATION and RELEASE
I, the above named applicant, certify that the information I have provided is complete and correct. I authorize SSS staff to obtain
records or data in support of my application from other sources, and to release information as required by the grant-funding agency of
the United States Government. I agree that if I am accepted into SSS, program staff may have access to my academic and financial
aid records and may include my name as a participant in SSS publications. Note: SSS is a federally funded TRIO program. The US
Dept. of Education requires reporting by Social Security number. If accepted into the program, you will be required to provide
this information.
_____________________________________ _____________________
Student Signature (Please type student name) Date
Advising and Career:
□ Understanding/Applying for
VA/Military Benefits
□ Career Planning
□ Choosing a Major
□ Transfer Planning
□ Goals/Decision Making
□ Financial Aid Advising
Other:
□ Financial Literacy
_________________________
Academic Skills:
□ Time Management
□ Study Skills
□ Test Taking/Test Anxiety
□ Reading Comprehension
□ Writing
□ Organization
□ Note Taking
□ Math Skills
□ Basic Computer Skills
□ Tutoring
□ Learning Strategies
