Impact Programs at Aims
SSS-Classic * SSS-STEM * CORE Application
Rev 09/14/2015
Aims Community College
TRIO & CORE Impact Programs
P.O. Box 69 College Center 220
Greeley, CO 80632 Phone: 970-339-6372
Please return completed application to the TRIO & CORE Impact Programs office in College Center 220. Your application
will be reviewed and we will notify you if you meet the eligibility requirements. If you have any questions please contact
Erin Wolfe, Staff Associate, at 970-339-6372 or e-mail
(Please print in ink) Date: ________________________________
Name: ______________________________________________________ Aims #: ______________________________
Last First M.I.
Address: __________________________________________________________________________________________
Street City State Zip
Primary Phone: ____________________ Secondary Phone: _____________________ Date of Birth: ________________
E-mail: ______________________________________ Future Career Title: ____________________________________
Do either of your parents have a Bachelor’s degree (4 years)? Yes No
Do you have a documented disability? Yes No
If yes, have you submitted documentation to the Disability Access Center? Yes No
(Prior to admittance into program in this category, student must provide documentation to Disability Access Center.)
Are you currently a part of Emerging Scholars? Yes No
Have you completed a Degree from any College/University? Yes No
Name of other Colleges/Universities attended: ____________________________________________________________
Gender: Are you Hispanic/Latino? Race (Check all that apply.)
Male Yes Yes No
Female No   American Indian/Alaskan Native
  Asian
Citizen or Permanent Resident of the United States:   Black or African American
Yes   Native Hawaiian/Pacific Islander
No-If no, skip Income Verification section   White
Income Verification:
Did you and/or your parents file income taxes last year? Yes No
Number of people in your household (please include yourself): _________
Your answers to questions on the FAFSA determine whether you are considered a dependent or independent student. If
you did not file a FAFSA application, please visit to determine if
you would be considered dependent or independent. Please include your parent(s’) taxable income if you are dependent or
taxable income from your latest tax return if you are independent. Depending on which tax form was filed, you will find
the amount of your taxable income either: 1040EZ-line 6; 1040-line 43; 1040A-line 27.
Taxable Income (not adjusted gross income “annual salary”): __________________
Parent or Legal Guardian Signature: __________________________________________ Date: _____________________
Dependent Students Only
click to sign
click to edit
Impact Programs at Aims
SSS-Classic * SSS-STEM * CORE Application
Rev 09/14/2015
Enrollment: (check one)
I have applied to Aims but am not in classes I plan to begin classes Fall 20___ Spring 20___ Summer 20___
I am currently taking classes at Aims
I am returning to Aims
I transferred to Aims
Financial Aid:
Have you applied for financial aid at Aims? Yes No
If you have applied, are you receiving aid this semester? Yes No
What types of financial aid are you receiving _____________________________________________________________
If you did not apply for financial aid this semester, please explain why: ________________________________________
Educational Data:
Name of High School: ___________________________________________ Graduation Date: _____________________
Date Received GED: ___________________________________________________
College Plan:
I plan to earn an Associate degree from Aims Yes No Intended Major/Career Path: ______________________
I plan to transfer to a 4-year college/university Yes No Institution: ____________________________________
What types of services would be beneficial to you?
Academic Advising Career Planning Tutoring Workshops Mentoring
Financial Aid Advising Transfer Advising Financial Literacy Leadership Opportunities
Other ______________________________________________________
Have you been a TRIO Program participant previously?
Education Opportunity Center (EOC) McNair Educational Talent Search (TS)
Upward Bound (UB) Upward Bound-Math Science (UB MS)
Veterans Upward Bound (VUB) Student Support Services (SSS)
How were you referred to the TRIO & CORE Impact programs: ______________________________________________
TRIO Impact Programs provide individualized services addressing specific needs of students as they confront the challenges
of completing a college certificate or degree. I certify, under penalty of perjury, that the information I have provided on this
form is true and complete without evasion or misrepresentation. I understand that if found otherwise, it is sufficient cause
for dismissal from the TRIO & CORE Impact Programs. If asked by an authorized official, I agree to provide proof of the
information I have provided.
I understand TRIO & CORE staff at Aims will utilize the information provided to assess my academic, career, and financial
aid planning needs. I understand this information will be used in strictest confidence. I give my permission to release
information that will assist TRIO & CORE staff in ongoing evaluation of my academic pursuits. I acknowledge that TRIO
& CORE staff will assist me in achieving my academic goals only if I fulfill my obligations as agreed upon by TRIO &
CORE staff and myself.
By signing this form, I acknowledge and understand that the TRIO SSS programs are federal grant-funded programs from
the U.S. Department of Education and services provided to me are contingent on continuation of funding. I understand that
the level of TRIO & CORE services may change due to changes in funding.
Student Signature: ___________________________________________ Date: __________________________________
click to sign
click to edit
Impact Programs at Aims
SSS-Classic * SSS-STEM * CORE Application
Rev 09/14/2015
Program overview:
Academic Tutoring
Campus Visits
Cultural Events
o financial, personal, academic,
career, or transfer
Meet with an Impact Programs advisor for a minimum of three
required advising appointments each semester;
Attend a minimum of two additional activities per semester.
Including, but not limited to:
o Student Lingo, iFocus, Human2Human, student
organizations, or student government association, or other
workshops and activities presented by the Impact Center;
Complete 3 hours of financial literacy education by the end of my
first semester with the Impact Programs; and
Maintain a 2.3 cumulative GPA
Please complete the following questions:
1. Please describe your academic and career goals.
2. Please describe your academic success network. (i.e. family, friends, partner, mentor)
3. What do you hope to gain from your participation in the TRIO & CORE Impact Programs?
Understanding the expectations of our programs, what challenges might affect your level of participation in the TRIO &
CORE Impact Programs, or your educational goals? Mark all boxes that apply.
Please Explain
Lack of transportation
Employment (# of hours)
Family responsibilities
No previous college experience