Background Information:
Have either of your biological or adoptive parents earned a bachelor’s degree or higher?
Yes-Mother Yes-Father Neither Unsure/Unknown
Have you earned a bachelor’s degree or higher? Yes No
Do you have any documented disability? Yes No
If YES, is this information on file with CCA’s Office of Disability and Equity? Yes No
If you would like to disclose your disability, please do so here (This voluntary information will be kept
confidential. Refusal to provide it will not subject the applicant to any discrimination on the basis of
handicap): __________________________________________________________________
What credential are you currently working towards at CCA?
Certificate Associate of Arts Associate of Science Associate of General Studies
Associate of Applied Science Articulated Degree None/Fulfilling Prerequisites
Do you plan to transfer to a 4-year university to obtain a Bachelor’s degree?
Yes No
Program Benefits include:
• A dedicated academic coach
• Tutoring in English, Math and/or Science
• Assistance with academic and degree
planning
•
Access to cultural events and activities
• Assistance with the transfer process
(transfer exploration, application
completion, financial aid and scholarships)
TRUTH STATEMENT: The information provided on this form is, to the best of my
knowledge, accurate and true.
_____________________________________________ ______________________
Student Signature Date
Please return your completed application to:
Student Success Center -TRIO Student Support Services-English as Second Language
16000 E. Centretech Parkway, Student Center S101 or S203
Phone: 303-360-4754 Email: trioesl@ccaurora.edu
The below documents may be required of you during an interview if you are eligible for the program:
• A copy of the previous year tax returns
• Permanent resident card or proof of citizenship status (If the applicant is a non-citizen)
click to sign
signature
click to edit
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