Office Use Only - TRCC STUDENT IDENTIFICATION #: ____________________
574 N ew Lo ndon Turnpik e No rwic h CT 0636 0 8 60/2 15-90 00
COLLEGE CAREER PATHWAYS PROGRAM – APPLICATION
Three Rivers Community College does not discriminate against any individual on the grounds of race, color, religion, political
beliefs, national origin, physical handicap, criminal record, sex, sexual preference, marital status, ancestry, or age.
APPLICANT INFORMATION (Please Print)
Social Security # __ __ __ - __ __ - __ __ __ __ Date of Birth: __ __ / __ __ / __ __ __ __ Gender: Male / Female
Social Security Number is requested for purposes of financial aid,
Federal income tax benefits, the provision of some college services,
accuracy of student records and other business purposes.
Last Name: ________________________________ First Name: ________________________________ MI: ___
Mailing Address: ______________________________________________________________________________
Phone : (__ __ __) __ __ __ - __ __ __ __ Home
I request the College forward to me at the e-mail address I have provided any
correspondence, including personally identifiable information pertaining to me
from College records that are protected by FERPA. Initial _________
High School Name: _____________________________________________________________________________
Anticipated Graduation Year: __________ Is this your first Three Rivers CCP course? YES NO
What course do you anticipate registering for? _______________________________________________________
Please provide the following race and ethnic data. This information is requested on a VOLUNTARY basis by the U.S. Department of Education, National
Center for Education Statistics. Your answer will not affect admission to or registration in the CCP program or TRCC.
Do you consider yourself to be Hispanic/Latino? YES
Are you a U.S. Citizen? YES
What is your race? White (10) _____ Black or African American (20) _____ Asian (45) _____
American Indian or Alaskan Native (50) _____
Native Hawaiian or Other Pacific Islander (80) _____ Other (90) _____
Do either of your parents hold a Bachelor’s Degree (4-year-college-degree) or Higher? YES NO
The College Career Pathways (CCP)
program is a concurrent enrollment
program administered by Three Rivers
Community College (TRCC). Students
gain exposure to the academic
challenges of college while in their
supportive high school environment,
earning transcripted college credit at
the time they successfully pass the
course. Concurrent enrollment also
facilitates close collaboration between
high school teachers and college faculty
that fosters alignment of secondary and
CCP Instructors - CCP courses are taught
during the regular high school day by
qualified high school teachers who have
been certified as adjunct instructors for
TRCC by corresponding academic
CCP Courses - CCP courses taught by
high school instructors are as rigorous
as the TRCC on-campus counterpart.
TRCC and each high school collaborate
to ensure the content, assignments, and
assessments of CCP courses is the same
as courses offered on the TRCC campus.
CCP Students - When enrolled in a CCP
course, you become a TRCC student and
you are responsible for all the policies
that effect students enrolled at TRCC.
Please review the Student Handbook.
_ __ __ _ __ __ _Phone : (_ __) _ __ - _ __ Cell