Fillable TRiO Scholars Application | College of the Redwoods, (College of the Redwoods)

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TRiO Scholars Application | College of the Redwoods, (College of the Redwoods)

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The TRiO Scholars Application | College of the Redwoods, (College of the Redwoods) form is 5 pages long and contains:

  • 1 signature
  • 36 check-boxes
  • 70 other fields

Country of origin: US
File type: PDF

U.S.A. forms for College of the Redwoods

BROWSE COLLEGE OF THE REDWOODS FORMS

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First Name: Middle Initial:
Last Name: Student ID:
Birthday:
/ /
Social Security #:
Are you a U.S. Citizen?:
 Yes  No
If No, are you a permanent resident?:
 Yes  No
Street Address/Apt#:
City:
State: Zip:
Email:
Phone:
Phone Type:
 Cell  Landline
Ok to text?:
 Yes  No
Can we connect with you on social media (Facebook, Instagram, etc.)?:
 Yes  No
Gender:
 Male  Female
Ethnicity (Please select all you identify with):
 Asian  Black/African American  Caucasian/White  Hispanic/Latinx
 Native American/Alaska Native  Native Hawaiian/Pacic Islander  Multi-Racial
Academic Goal:
 Certicate (1-2 year  Associate’s Degree (2 year) Transfer to Bachelor’s Degree (4 year)
Do you have a High School Diploma or GED?:
 High School Diploma  GED
Do you have an Associate’s or Bachelor’s degree?:
 No  Associate’s Degree  Bachelor’s Degree
Did either of your parents complete a Bachelor’s (4-year) College Degree?:
 Yes  No
Did you complete the FAFSA?:
 Yes  No
Do you have a documented disability?:
 Yes  No  Unsure
1. PROGRAM ELIGIBILITY QUALFIER
TRiO Scholars Application | College of the Redwoods, Del Norte
STUDENT SUPPORT SERVICES
2. ACADEMIC QUALIFIER
3. COMMITMENT TO TRIO SERVICES
Please indicate in the space below at least 2 TRiO Services you will commit to using this Semester.
Working one-on-one with a TRIO staff member
Meeting with a Counselor/Advisor to discuss my goals.
Tutoring (In Person and/or in a Study Group)
Online Tutoring
Attending a Workshop (Study Strategies, Financial Planning, Career Exploration, Transfer, etc.)
Online Workshop
Career Planning
Financial Planning Meeting (FAFSA, Financial Aid, Scholarship Applications, Budgeting)
Utilizing the Technology Library (Textbooks, Calculator, Laptops on Reserve)
Transfer Assistance (College Trips, Assistance Applying to a University, Transfer Advising)
I do not always feel comfortable reaching out for help. (Especially Professors, Tutors, Counselors etc.)
I am not sure I feel prepared to take college-level courses such as Math, English, Science…etc.
I have a history of academic difculties or not passing classes.
I received non-passing or low grades in high school.
I received non-passing or low grades in college.
I am unsure of my career and/or education goals.
My education goals require an ambitious (higher) Grade Point Average (GPA).
I have been out of school for 5 or more years.
English is not my rst language.
Reading, Writing, and communicating my thoughts in writing can be challenging for me.
I have found college processes to be overwhelming or confusing.
I have commitments beyond school. (ex: work, family, caregiving)
I experience high levels of stress/feeling overwhelmed.
I am not sure if college is “right” for me or my lifestyle.
I could use some help with learning how to study, research, notetaking, time management, etc.
I could use some help completing Financial Aid processes (such as FAFSA).
I am not sure I can afford to go to college.
I have participated in similar Academic Success programs like Upward Bound, Talent Search…etc.
Other
1. I agree to participate in at least 2 TRiO Services each semester.
2. I will do my best to make progress towards my Education Goals.
3. I understand that a TRiO staff member may contact me at any time to check in about this progress.
4. I also understand that if I do not utilize TRiO Services, I may be removed from the program.
5. I will notify TRiO staff if I decide not to return next semester.
/ /
Student Signature Date
4. CONTRACT
4. CONTRACT
4. CONTRACT
STAFF USE ONLY
By signing the below, I am conrming that all the information within this application is complete and accurate to the best fo my knowledge. I understand that by applying
to the TRiO SSS program, I authoize program staff to obtain records or data pertinent to my participation from other campus ofces and to relase information to the
U.S. Department of Education for reporting purposes. The personal information I provive is protected by the Family Educational Acts and Pricacy Act (FERPA), and will
be kept condential.
Action: Admit Waitlist Not eligible
Notes:
Directors Signature
/ /
Date
click to sign
signature
click to edit
DEPENDENT STUDENT INCOME VERIFICATION
1. Please have your parent/legal guardian ll out and sign steps 1-3 of the TRiO Application
to verify your income:
2. Please have your parent/legal guardian select one of the following boxes below ()
& complete the necessary information:
3. Please have your parent/legal guardian sign below:
Thank you. Please feel free to contact the TRiO Ofce 707-465-2320 if you have any questions.
I (full name) , declare that I am the parent
or legal guardian of (student’s name)
.
I conrm that the above information is true and accurate to the best of my knowledge.
Parent/legal guardian’s Signature:
Date: / /
Parent/legal guardian’s Printed Name:
I did not le a tax return because my earned income was: $
I led a tax return.
My taxable income (1040EZ - Line6; 1040A - Line 27; 1040 - line 43) was: $
Size of
Family Unit
48 Contiguous States, D.C., and Outlying Jurisdictions Alaska Hawaii
1 $18,090 $22,590 $20,790
2 $24,360 $30,435 $28,005
3 $30,630 $38,280 $35,220
4 $36,900 $46,125 $42,435
5 $43,170 $53,970 $49,650
6 $49,440 $61,815 $56,865
7 $55,710 $69,660 $64,080
8 $61,980 $77,505 $71,295
For family units with more than eight members, add the following amount for each additional famity member: $6,270 for the 48 contiguous
States, the District of Columbia, and outlying jurisdictions, $7,845 for Alaska; and $7,215 for Hawaii.
Federal TRIO Programs Current-year Low-Income Levels (Effective January 31, 2017 until further notice)
STUDENT SUPPORT SERVICES
(Skip page if "Independent" student on FAFSA)
INDEPENDENT STUDENT INCOME VERIFICATION
1. Please ll out and sign steps 1-3 of the TRiO Application below to verify your income:
2. Please select one of the following boxes below () & complete the necessary information:
3. Please sign below:
Thank you. Please feel free to contact the TRiO Ofce 707-465-2320 if you have any questions.
I (full name) ,
declare that I am legally an independent student.
I conrm that the above information is true and accurate to the best of my knowledge.
Signature:
Date: / /
Printed Name:
I did not le a tax return because my earned income was: $
The total number of people (exemptions) living in my household (including myself) is: ______.
I led a tax return.
My taxable income (1040EZ - Line6; 1040A - Line 27; 1040 - line 43) was: $
The total number of people (exemptions) living in my household (including myself) is: ______.
Size of
Family Unit
48 Contiguous States, D.C., and Outlying Jurisdictions Alaska Hawaii
1 $18,090 $22,590 $20,790
2 $24,360 $30,435 $28,005
3 $30,630 $38,280 $35,220
4 $36,900 $46,125 $42,435
5 $43,170 $53,970 $49,650
6 $49,440 $61,815 $56,865
7 $55,710 $69,660 $64,080
8 $61,980 $77,505 $71,295
For family units with more than eight members, add the following amount for each additional famity member: $6,270 for the 48 contiguous
States, the District of Columbia, and outlying jurisdictions, $7,845 for Alaska; and $7,215 for Hawaii.
Federal TRIO Programs Current-year Low-Income Levels (Effective January 31, 2017 until further notice)
STUDENT SUPPORT SERVICES
(Skip page if "Dependent" student on FAFSA)
By signing this letter, I approve Disability Services and Programs for Students (DSPS) to indicate my involvement
with the program for the purpose of fullling verication for my TRiO Application. I understand that no additional
information will be provided pertaining to any specic disability, accommodation, or service.
Student Support Services (SSS) TRiO
DSPS Verication Form
/ /
DATE:
STUDENT ID:
SIGNED BY (YOUR PRINTED NAME):
SIGNATURE:
STUDENT SUPPORT SERVICES
PHOTO/VIDEO RELEASE FORM
I hereby irrevocably consent to and authorize the use and reproduction by
Redwoods
Community College District
, on behalf of
College of
the Redwoods
and its agents
or employees, photographs/videos taken of me for use in internal and external marketing and
communication efforts by
College of the Redwoods.
Usage may include, but is not limited to: websites, social media, newspapers, radio
and television broadcasts and/or in print materials. College of the Redwoods is not obligated to inform me of usage and I hereby waive any
right to inspect or approve the finished photographs/videos or the content in which they appear, now or in the future - whether that use is
known to me or unknown, and I waive any right to royalties or other
compensation arising from or related to the use of the photograph/vi
deo.
I hereby agree to release, defend, and hold harmless Redwoods Community College District, on behalf of College of the Redwoods
and its agents or employees, including any firm publishing and/or distributing the finished product in whole or in part, whether on paper, via
electronic media, or on web sites, from and against any claims, damages or liability arising from or related to the use of the photographs/videos,
including but not limited to any misuse, distortion, blurring, alteration, optical illusion or use in composite form, either intentionally or
otherwise, that may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution.
I am 18 years of age or older and I am competent to contract in my own name. I
have read this release before signing below, and I fully
understand the contents,
meaning and impact of this release. I understand that I am free to address any specific questions regarding this
release by submitting those questions in writing
prior to signing, and I agree that my failure to do so will be interpreted as a free and
knowledgeable acceptance of the terms of this release.
COLLEGE OF THE REDWOODS | 7351 Tompkins Hill Rd., Eureka, CA 95501
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TRiO Scholars Application College of the Redwoods, (College of the Redwoods)

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Completed 3 September 2020

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