SJC - TRIO STEM 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 *
Address
Mailing Address (if different)
City
State
Zip
Cell Phone Number
SJC Email Address *
What is your Citizenship Status? *
Ethnicity:
Do you identify as Hispanic or Latino? *
Do you identify as White or Caucasian? *
Do you identify as American Indian or Alaskan Native? *
Do you identify as Asian? *
Do you identify as Hawaiian/Pacific Island? *
Do you identify as Black or African American? *
Academic Information:
Are you registered for classes at SJC?
What is your major or degree of interest?
Current College Level
Have you previously earned a college degree?
Referral Information: 
Who referred you to or how did you hear about TRIO SSS program?

 

Participation in other Support Programs:
Did you participate in TRIO Upward Bound?
Did you participate in Talent Search?
Did you participate in TRIO SSS (at another college/university)?
Did you participate in TRIO EOC?
Did you participate in the McNair Scholars program?
Did you participate in GEAR UP?
Did you participate in Herencia Latina Center?
Did you participate in the Native American Center?
Did you participate in a Veteran Center?
Did you participate in Accessibility Services?
Do you participate in services provided by the Student Resource Center?
Do you currently participate or receive Mental Health Counseling at SJC?
If you did not receive or participate in any of these programs? Please select this option.
If you selected "Other" please specify below what other programs you are currently a participant in or previously participated in?

Self Needs Assessment: Please check all the areas in which you feel SSS staff may be able to assist you: 
Academic Advising
San Juan College Processes & Policies
Course Planning
Career Planning
Support & Referrals
Degree Audit/Pre-Advising
First Year Experience
Transition to College
Time Management
Communication Skills
Note-taking, study, & test-taking skills
Tutoring
Financial Aid/Scholarship Advising
One-on-One
Group
Online
Financial Aid & Economic Literacy
Workshops on budgeting,credit, student loans, saving,etc
Resource Materials
Online Tools & Apps
Graduation & Transfer Support
Graduation Application Assistance
University Campus Visits
Transfer Advising
Workshops & Fairs
Financial Aid
Assistance in completing FAFSA/Scholarship Applications
Health & Wellness Programming
Physical Health
Mental Health
Social Connections
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?
If you selected "Other" in the previous question, please specify, who else you reside with?
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)? *
Dependency Status
Which of the following best describes your status?
Dependent Student-Under 24 years of age, not married, not a veteran or active-duty military, do not have children who receive more than half of their support from you, and not an orphan or ward/dependent of the court.
Independent Student-24 years of age or older, or any of the following apply: married, a veteran or active-duty military, have children who receive more than half of their support from you, or an orphan or ward/dependent of the court.

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 STEM-H 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.