SJC - TRIO Classic Application
Thank you for your interest in our Student Support Services program!  Please complete this application as thoroughly as possible.  You cannot save and restart this application.  You may want to review the included items, take some time to make notes, and then return to submit your application.  If you have any questions, please call our office at (505) 566-3147.

Student Information:
SJC ID# *
Last Name *
First Name *
Middle Name *
Date of Birth *
Gender *
Marital Status *
Permanent Address *
Mailing Address (if different) *
City *
State *
Zip Code *
Student Cell Phone Number *
SJC Email Address *
What is your Citizenship Status? *

Referral Information:
Please indicate which educational programs you have previously participated or currently participate in?
Who referred you to or how did you hear about TRIO SSS program? *

Academic Information:
Current College Level *
Have you previously earned a college degree? *
Are you registered for classes at SJC? *
Major or Degree of interest? *
Race & Ethnicity:
Do you identify as Hispanic or Latino? *
SA Ethnicity *
Family Information:
How many total people live in your home? (Including yourself) *
Family Income Range *
Has your mother earned a 4-year degree? *
Has your father earned a 4-year degree? *
Before the age of 18, with whom did you primarily reside? *
Do you have a documented disability, that may qualify you for academic accommodations or support services? *
Do you currently receive or qualify for federal or state financial aid (such as FAFSA, Work-study, or scholarships based on financial need)? *
Have you served or are you currently serving in the U.S. Armed Forces (active duty, reserves, or National Guard)? *

Self Needs Assessment

 
Academic Advising
Topics to be assisted with: *
First Year Experience
Additional Assistance:
Tutoring
Tutoring Service types interested in:
Financial & Economic Literacy
Additional topics:
Graduation & Transfer Support
Topics needing assistance with: *
Financial Aid
Additional topics for Financial Aid Assistance: *
Health & Wellness Programming
Other topics related to health: *

Certification, Signature & Date

I certify that the information provided in this application is accurate and complete to the best of my knowledge. 

I authorize TRIO Student Support Services to access necessary information from my educational records, including (but not limited to) transcripts, placement test scores, grades, and instructor contacts. 

I also authorize TRIO to share relevant information about me with other San Juan College offices-such as Accessibility Services, Records, Counseling, and Financial Aid--on a need-to-know basis, in compliance with the Family Educational Rights and Privacy Act (FERPA). 
Applicant Signature: *
Please select a signature verification type.

Parent/Guardian Signature (Required for Dependent students): By signing below, I certify that the information provided in this form is true and complete, to the best of my knowledge. I understand that the TRIO SSS Program may contact me for clarification or verification of this information and that TRIO may verify information with San Juan College offices as necessary. 

Note: A drawn signature is required for verification purposed. If a parent/guardian is not present to sign the application, use the Verify by text or Verify by email options to collect a digital signature from the parent/guardian. The TRIO team will reach out to confirm the information and obtain a drawn signature to complete the application, as needed. 

Special Instructions for Independent Students: If you are an independent student, according to your most recent FAFSA, please sign in the student signature section, make an "X" in the Parent/Guardian signature pad, and type "Independent Student".
Parent/Guardian Signature: *
Please select a signature verification type.