Fillable Cape Cod Community College Advantage (TRiO SSS) Application (Cape Cod Community College)

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Cape Cod Community College Advantage (TRiO SSS) Application (Cape Cod Community College)

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The Cape Cod Community College Advantage (TRiO SSS) Application (Cape Cod Community College) form is 4 pages long and contains:

  • 2 signatures
  • 45 check-boxes
  • 72 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Cape Cod Community College

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FORM REVISED 5/13/2020
Cape Cod Community College
Advantage (TRiO SSS) Application 2020
Phone: 774-330-4321 Office: Maureen M. Wilkens Hall Room 221
The Advantage (Student Support Services) Program is a federally funded TRIO Program under the U.S.
Department of Education established to aid students in graduating from college. Students participating in the
program’s activities must meet certain requirements set forth by the Department of Education. To determine
your eligibility please fill out the following information as completely as you can. The information you provide
is kept strictly CONFIDENTIAL.
Applicant Name: ______________________________Preferred Name:________________________________________
Social Security #:________________________CCCC Student ID#_________________Date:________________________
Mailing Address: ___________________________________________________________________________________
City: _______________________________________________ State: ______________ Zip: _______________
Email: ______________________________ Birth Date: ___________________Gender: M__________F_________
Cell Phone #: __________________________ Home Phone #: ___________________________
Emergency Contact Name: ________________________________ Phone:____________________________
***********************
Marital Status: Single ______Married _______Separated ________Divorced _______Widowed_______
Do you have any Dependents/Children: Yes_____No_____ If yes, how many? _____
Are you homeless or in danger of becoming homeless? Yes_____No_____
Are you in foster care? Yes_____No_____
Is English your second language? Yes_____No_____ If yes, what is your first language?__________________
Ethnic Background: Check All that Apply
___ Hispanic or Latino
___ White or Caucasian
___ American Indian or Alaskan Native
___ Native Hawaiian or other Pacific Islander
___ Asian
___ Cape Verdean
___ Black or African American
FORM REVISED 5/13/2020
Are you a U.S. Veteran? Yes______No_______
Citizenship: U.S. Citizen_____ or Permanent Resident [Alien Registration #]______________________________
Did you graduate from high school? Yes____No____ Name of High School_____________________________________
Year of Graduation______
OR
Do you have a GED or HISET Diploma? Year awarded___________________
Do you plan to graduate with an Associate’s degree from CCCC? Yes______ No______Unsure________
Will you be a full time student? (12 Credits/4 classes or more) Yes______ No______Unsure_______
Do you plan to transfer to a 4 year College or University? Yes _______ No_________Unsure_____
What will be your major? ________________________________________________________________
Have you attended a College other than Cape Cod Community College? Yes _________ No _________
If yes, name of College? ___________________________________# of credits completed____________
Income verification
I am (circle one) Independent Dependent
You are automatically considered independent if you are 24 or older. If you are under 24, you will be considered
independent if you are:
Married
A student with legal dependents other than a spouse
A veteran of U.S. Armed Forces
An active duty member of the U.S. armed forces (not for training purposes)
An orphan or ward of court
A Parent
If you are a dependent, please use the 2019 taxes on which you are listed as a dependent. If you are
independent, please use your 2019 taxes.
2019 tax filing status (Circle one)
Single Married filing jointly Head of household Married filing separately
2019 taxable income $________________________________
(line 43 on form 1040 or line 6 on form 1040EZ)
2019 family size __________
Please include the person who filed taxes, their spouse if filing jointly, and all dependents included in the tax return.
Parent/Legal Guardian Name (Please Print)___________________________________________________________
Parent/Legal Guardian Signature______________________________________________Date____________________
(needed only if student is a dependent)
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FORM REVISED 5/13/2020
Have you completed your FAFSA for 2020/2021? Yes________ Have not yet applied_____
Has either parent or guardian graduated from college with a Bachelor’s Degree or higher?
Yes _____ No_____
Do you have a documented learning or physical disability? Yes_______ No______
If yes, please describe: _______________________________________________________________________________
__________________________________________________________________________________________________
If you have a documented disability, are you working with the O’Neill Center for Student Access and Support at CCCC?
Yes_____ No_____
Are you working with Mass Rehab? Yes______ No_____
Please tell us why you wish to participate in The Advantage Program and how you think we can help you be successful
at CCCC.
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
How did you learn about the Advantage Program?
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Which of the following Advantage Program services would be of interest to you? Check all that apply
Advantage Program Services Student Success Seminar Topics
Academic Advising
Adjusting to college
Basic Skill Improvement (math, writing, reading,
computer skills, etc.)
Learning style identification
Career Counseling/Advising
Life planning
Computer help
Nutrition/ personal health
Education Tools ( calculators, recorders, flash drives,
reference books)
Stress management
Financial Aid planning/monitoring
Test anxiety
Financial Literacy
Test taking strategies
Transfer Planning
Time management
Visits to four year colleges
Using technology
Personal Advising
Note-taking & study skills
Scholarship information
Writing a research paper
Computer use/internet access
Resume writing
Tutoring
Library resources and use
Cultural Events/Community Service
Memory
FORM REVISED 5/13/2020
I,__________________________________, authorize Advantage (TRiO Student Support Services) Program to
gather information concerning my academic progress (standardized test scores, grade point average, earned credit,
transcripts, tutoring, etc.) financial aid status, and verification of documented disability prior to my participation in The
Advantage Program. I understand that this information is used to help determine my eligibility for The Advantage Program
and kept strictly confidential. I grant permission for Advantage Program staff to gather information for follow-up
whenever appropriate, including, but not limited to transfer and progress to 4-year institutions. I am aware that my
eligibility and financial aid status will be reported to the U.S. Department of Education in accordance with the grant
funding regulations. I certify that the information provided on this application is true and complete to the best of my
knowledge. I also agree to provide documentation upon request to verify the information reported.
I am also aware that personal information that is provided to Advantage (TRiO Student Support Services) will be protected
under the Federal Educational Rights & Privacy Act (FERPA) of 1974. No one will have access to the information unless
they work with or for SSS, or are specifically authorized by me to see the information.
I am aware that I could be dismissed from the Advantage (TRiO SSS) Program for inappropriate behavior with staff,
faculty, tutors, and/or other college personnel.
I am also aware that I could be dismissed from the Advantage (TRiO SSS) Program for lack of participation in program
services.
Student’s Signature: ___________________________________________________ Date:
_________________________
Return application to: advantageprogram@capecod.edu
For Office Use Only
Date Received_________________Date Approved____________________Date Denied______________________
Reason for Denial________________________________________________________________________________
Eligibility_________________________________Need_______________________Cohort Year_________________
Eligibility
1. Low income and first generation
2. Low income
3. First generation
4. Documented disability
5. Low income and documented disability
Need
1. Low high school grades 8. High school equivalency 15. Need for academic support
2. Low admissions test scores 9. Failing grades to raise grades
3. No longer used 10. Out of the academic pipeline for 5+ years 0. No response/unknown
4. No longer used 11. Other
5. Predictive indicator 12. Limited English proficiency
6. Academic proficient test 13. Lack of educational/career goals
7. Low college grades 14. Lack of educational preparedness for college
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Cape Cod Community College Advantage (TRiO SSS) Application (Cape Cod Community College)

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Completed 29 January 2021

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