Fillable TRIO Program Application Students who wish to participate (Kapiolani Community College)

Fill Online, Printable, Fillable, Blank TRIO Program Application Students who wish to participate (Kapiolani Community College) Form

Use Fill to complete blank online KAPIOLANI COMMUNITY COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

TRIO Program Application Students who wish to participate (Kapiolani Community College)

On average this form takes 14 minutes to complete

The TRIO Program Application Students who wish to participate (Kapiolani Community College) form is 3 pages long and contains:

  • 0 signatures
  • 51 check-boxes
  • 31 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Kapiolani Community College

BROWSE KAPIOLANI COMMUNITY COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
1
Rev 7/27/20 BC
TRIO Program Application
Students who wish to participate in the TRIO program must complete this application and provide
supplemental information where necessary. Potential applicants for the program will be asked to
meet with a TRIO counselor for enrollment in the program. The information you provide is strictly
confidential.
SECTION I. PERSONAL INFORMATION
UH Student ID #
Male
Female
Date of Birth:
NAME: First:
Middle Initial:
Last:
Mailing Address:
City:
State:
Cell Phone #:
Daytime Phone #:
UH user name/email Address:
@hawaii.edu
Emergency Contact: (Name, Phone, Relationship)
ETHNICITY (Check all applicable)
Native American or Alaskan Native Asian Black or African-American
Hispanic
White Native Hawaiian or Other Pacific Islander
SECTION II. ELIGIBILITY CRITERIA (Check one)
a. U.S. Citizen
OR
b. Permanent U.S. Resident Resident Card #:
Annual family TAXABLE income:
(As listed on 1040 Income Tax Form)
$
Number of exemptions claimed on income tax
form: (As listed on 1040 Income Tax Form)
Did you apply for financial aid? Yes No
1
☐
Did you receive a Pell Grant? Yes No
Does your father have a Bachelor’s degree: Yes No
1
Does your mother have a Bachelor’s degree: Yes No
DISABILITY VERIFICATION
Yes No
Do you have a documented disability?
Are you registered with the Disability Support Services Offices (DSSO) at
KCC?
2
Rev 7/27/20 BC
S
ECTION III. ACADEMIC NEED (Check one)
Lack of educational or career goal
Out of educational pipeline for 5+ years
Need for academic support to raise grade(s)
in required courses in academic major
Lack of academic preparedness for
college-level course work
Limited English proficiency
SECTION IV. SECONDARY ACADEMIC NEED (Check all that are applicable)
Academic advising and course selection
Tutoring
Financial aid assistance (completing FAFSA)
Financial literacy
Financial aid assistance (scholarship
searches)
Assistance to transfer to a 4-year
educational institution
SECTION V. YOUR EDUCATIONAL BACKGROUND (Check all applicable)
High school graduate
Associate degree:
Bachelor’s degree:
SECTION VI. PRESENT STATUS AT KCC (Check one)
New student
Continuing student
Returning student
Current semester:
The number of credits enrolled:
Current grade point average:
SECTION VII. ENGLISH/MATH PLACEMENT (If known)
Math placement level:
English placement level:
SECTION VIII. EDUCATION/CAREER OBJECTIVE
KCC Objective: A.A. / A.S. degree only Transfer only A.A. & transfer 1
Major:
Minor:
SECTION IX. OTHER INFORMATION (Check all that apply)
What other federally funded programs are you enrolled in at KCC? (Check all that apply)
STEM Kūlia ma Kapi‘olani Other
Have you in the past participated in a TRIO program such as UPWARD BOUND?
YES NO 1
SECTION X. HEARD ABOUT TRIO FROM (Check all that apply)
High School Counselor
Presentation
KCC Counselor
New Student Orientation
KCC Instructor
TRIO Postcard
Friend
TRIO Participant
3
Rev 7/27/20 BC
I authorize the TRIO-SSS program staff to access my University of Hawaii system records (including
those at the KCC Financial Aid and Admissions and Records offices) for the purposes of
determining program eligibility and audits and statistical reporting. By signing below, I verify that the
information I have submitted on my TRIO-SSS application is true and complete to the best of my
knowledge. Failure to provide necessary documentation may be cause for denial and/or cancellation
in the Program. I also give the TRIO-SSS program permission to verify the information on my
application as necessary and to monitor my academic progress while enrolled at KCC.
I agree to allow the TRIO-SSS Program to use my name and/or photograph in newsletters, press
releases, and other such announcements until I specifically request in writing that my name and/or
photograph not be used for these purposes.
**Privacy Act: In accordance with the Privacy Act of 1974 (Public Law No.93-579, U.S.C. 552a), you
are hereby notified that the Department of Education is authorized to collect information to
implement the Student Support Services Program under Title IV of the Higher Education Act of
1965, as amended (Pub. Law 102-325, Sec. 402D). In accordance with this authority, the
Department receives and maintains personal information on participants in the Student Support
Services program. The principal purpose for collecting this information is to administer the program,
including tracking and evaluating participant progress. Providing the information on this form,
including a social security number (SSN) is voluntary; failure to disclose a SSN will not result in the
denial of any right, benefit or privilege to which the participant is entitled. The information that is
collected on this form will be retained in the program files and may be released to other department
officials in the performance of their official duties.
Student Signature: Date:
TRIO-SSS is a federally funded program
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

TRIO Program Application Students who wish to participate (Kapiolani Community College)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 3 February 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document