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TRiO Student Support Services Program

TRiO Application

TRiO Program

970-521-6791

Sunday 4 p.m. to 9 p.m.
Monday 7:45 a.m. to 10 p.m.
Tuesday 7:45 a.m. to 10 p.m.
Wednesday 7:45 a.m. to 10 p.m.
Thursday 7:45 a.m. to 10 p.m.
Friday 7:45 a.m. to 5 p.m.
Saturday Closed

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Fields denoted with an asterisk (*) are required

Part 1: Personal Data

First Name

Last Name

The name I go by is:

Phone or Cell at which we can reach you at most

Local (NJC) Address

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

NJC Student Number (S#)

Birthdate

Birthdate: Month

Birthdate: Day

Birthdate: Year

Age

Gender at birth

Part 2: Race

Please select ALL that apply

American Indian/Alaskan Native

Asian

Black or African America

Native Hawaiian or Other Pacific Islander

White

Part 3: Citizenship

Are you a United States Citizen?

Part 4: Ethnic Origin

Hispanic/Latino (Select YES if you are a person of Cuban, Mexican, Puerto Rican, South or Central American or Spanish culture or origin)

Part 5: Educational Information

Please select what you graduated with

Graduation Year

Graduation Year: Year

NJC Major

What month/year was your first enrollment date at NJC? (Excluding classes taken while in high school)

What month/year was your first enrollment date at NJC? (Excluding classes taken while in high school): Month

What month/year was your first enrollment date at NJC? (Excluding classes taken while in high school): Year

Is your goal to transfer to a four-year college or university?

Do you have a documented disability that effects learning?

Part 6: First Generation Verification

Did your mother/legal guardian graduate with a 4-year Bachelor degree from a college or university?

Did your father/legal guardian graduate with a 4-year Bachelor degree from a college or university?

Who were you living with up to your 18th birthday?

Enter other…

Part 7: Need for Academic Services

Please check ALL the goals you may consider using for your educational support:

Academic Tutoring and/or Study Groups

Improve my study skills (note-taking, test-taking, textbook reading, writing, time management, etc.)

Assistance with Career or Personal Counseling

Assistance in transferring to a 4-year college

Assistance with Academic Advising

Assistance in obtaining and/or applying for financial aid

This program was developed under a TRIO Student Support Services grant from the Department of Education (DOE). However, activities do not necessarily represent the policies of the DOE, and you should not assume endorsement by the Federal Government.

AY2021