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.
General Information:
Are you a US Citzen or Permanent Resident? *
Legal Last Name *
Legal First Name *
Date of Birth *
Student Email Address: *
Cell Phone Number *
School ID *

Academic Info:
Are you a current ECC student? *
Which campus are you primarily on? *
Are you an Early College Academy student? (ECA) *
Eligibility Information
Please select the eligibility category that best describes you. *

Eligibility Verification

TRIO Student Support Services is a federally funded program that requires us to collect certain information to determine eligibility. The following questions may include personal information such as family education level, household income, or disability status and are used only for eligibility determination and required federal reporting.

Low-Income Information

TRIO programs are required to verify household income to determine eligibility. The income verification form linked here explains what information is needed and may require information about your parent or guardian’s income. Please review this form and complete all required sections. Students who do not complete the income verification form will not be able to use the low-income category to qualify for the program.
I have completed the income verification form *
Parent Education Information 
Did your mother earn a 4-year college degree? *
Did your father earn a 4-year college degree? *

Documented Disability Information
Medical documentation does not need to be submitted directly to TRIO if documentation is already on file with ECC Access Services and you authorize TRIO staff to verify your status.

If documentation is not on file, or if you do not authorize verification with Access Services, appropriate medical or professional documentation may be required to determine eligibility under the documented disability category.
Do you have disability documentation on file with ECC Access Services?
disability verification *
I authorize TRIO staff to verify disability documentation with ECC Access Services if applicable.
Access Info Release: *

Participation Commitment 
I understand that TRIO is an active support program and I am willing to participate in program activities if selected. 
Participation Commitment: *

Digital Signatures 

By signing this application, I attest that all the information on this application is true.  Moreover, I authorize the release of the student’s official academic records to the TRiO Student Support Services (SSS) project, understanding that the information in these records will be used only to assess the student’s need for TRiO program services, discern the student’s educational progress, evaluate the effectiveness of TRiO program activities, and fulfill TRiO program-reporting requirements.
Student Signature *
Please select a signature verification type.