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
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.
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: ______________________________________________________________________________
State Zip
Phone : (__ __ __) __ __ __ - __ __ __ __ Home
Email: ________________________________________
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
postsecondary curriculum.
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
Signature: ___________________________________________________ Date: ______________
Parent / Guardian Signature: ________________________________________________________________ Date: _________________
The information on this application is true and accurate and will be kept confidential according to the provisions of the Privacy Act. With your signature, you are allowing the
high school to release the student’s academic information and records. The student has my consent to participate in the Three Rivers College Career Pathways program.
The Family Educational Rights and Privacy Act (FERPA) affords students certain rights with respect to their
educational records. The rights reside with the student (not the parent), regardless of age, once he or she enrolls at
an institution of higher education. If a student wants to give permission to talk to a third party (i.e. parent, high school
instructor, school guidance counselor), they must file a disclosure document. A disclosure is a signed and dated
document provided by the student to authorize release of personally identifiable information (other than directory
information). The release must specify the records to be disclosed, the purpose of the disclosure and to whom the
information can be given to.
Date: ____________________
I, ________________________________________, hereby authorize
Student’s Name (PLEASE PRINT)
THREE RIVERS COMMUNITY COLLEGE and its employees to speak with
________________________________________ AND the faculty
Parent’s Name(s) or Other Designee (PLEASE PRINT)
and/or staff of ________________________________________
High School Name (PLEASE PRINT)
about my academic progress.
This document will be filed in the College Career Pathways office.
Signature: ___________________________________________________ Date: ______________
The CCP program allows credits you earn in
high school to be applied toward your college
education, as well as toward your high school
diploma. Upon graduating from high school,
these credits can be applied toward a program
of study at Three Rivers Community College or
you can request to have your transcript sent to
another college or university.
The College Career Pathways Advantage:
Free College Credits in High School
Save money on college tuition
Graduate from college early
Reduce your course load while in college
An opportunity for career exploration;
you can try a greater variety of courses
Graduate high school with a college
transcript - a plus when applying to
college or for a job
Immediate acceptance to Three Rivers
Community College
Demonstrate to college admissions
officials that you are capable to
succeeding in college-level courses
Preparation for highly skilled, high paying
jobs; College Career Pathways focuses on
math, science, communications, and
career related skills necessary to become
prepared for continued education and