Program Application

Thank you for your interest in the TRiO Student Support Services program!  Please complete this application as thoroughly as possible. 

IMPORTANT:  You cannot save and restart this application.  You may want to review the applications, take some time to make notes and gather the required documents, and then return to submit your application. 

If you have any questions, please call our office at (714) 564-6843.
How did you hear about the TRiO-SSS Program? *
I am applying for: *
General Information:
SAC School ID *
First Name: *
Middle Name:
Last Name: *
Date of Birth: *
Local Address *
Local Address 2
Local City *
Local State *
Local Zip *
Local Phone
Cell Phone Number: *
Check the box to accept text messages?
Email Address: *
College Email Address:
First Semester at Santa Ana College (i.e. Fall 2022)
Eligibility Criteria:
Citizenship Status: *
Is English your second language? *
Are you a First-Generation student? *
Demographic Information:
Ethnicity *
Gender: *
Preferred Gender Pronouns: *
Educational Background:
Name of the High School you graduated from? *
High School GPA *
Upload your high school transcript.
Degree Earned? *
In HS, did you ever have an Individualized Educational Plan (IEP)?
Other Colleges/Universities:
If you attended another college/university, which one(s) did you attend?
If you are a college student, what is your college GPA:
Highest degree earned:
Upload unofficial college transcripts here.
Are you currently participating or have participated in the past in any of the following programs? (Check all that apply).
Academic Talent Search
CalWorks
Disabled Student Programs & Services (DSPS)
Extended Opportunity Programs and Services (EOPS)
Guardian Scholars
Honors Program
Upward Bound Program
Veterans
Educational and Career Objective:
Educational Goal: *
University Name: (If unsure, write "Undecided"). *
Major: (If unsure, write "Undecided"). *
Career Goal: (If unsure, write "Undecided"). *
Academic Need:
If accepted to participate in the TRiO-SSS Program, I will require tutoring to successfully complete the: 
Math classes(s) to graduate and or transfer. *
English classes(s) to graduate and or transfer.
What are some of the reasons you believe you would benefit from participation in TRiO-SSS Program?
Low GPA in high school
Low admission test scores
Limited English Proficiency
Lack of educational and/or career goals (undecided on major)
Predictive indicator
Unprepared academically for college level work
Failing Grades
Academic support needed to raise grade(s) in required courses
College GPA in 2.0-2.5 range
Completed high school equivalency (GED)
Out of school for over 5 years
Income and Family Information:
Parents Educational Level: *
Have you submitted your FAFSA for this school year?
Are you receiving Public Assistance? (Cash Aid, Medi-Cal, SSI Benefits)
If Yes, specify type(s):
How many people do you/ your parents support? *
Family Income Range: *
Most Recent IRS 1040 (blur out any social security numbers and account information). See example below.
Sample picture of the 2020 IRS 1040 form

Interview/Photograph/Video Release Form

I hereby grant permission to Rancho Santiago Community College District to interview me and/or to use my likeness for still and/or video photography in its promotional materials and publicity efforts. I understand that the interview/photographs may be used in a publication, print ad, direct-mail pieces, electronic media (including video, CD-ROM, Internet/WWW), or other forms of promotion without further consideration. I acknowledge the college district’s right to crop or treat the photograph at its discretion. I also understand that if and when my image is posted on a college/district website, the image can be downloaded by any computer user. Therefore, I agree that no claims can be made against the colleges, the college district, or any of its representatives. Rancho Santiago Community College District understands and agrees that although it has received permission to use a photograph, the district is under no obligation to use any photograph it owns under its jurisdiction. 
My name

CERTIFICATION: I have read the requirements for the TRiO-SSS Program. All of the information provided by me or any other person on this form is true and complete to the best of my knowledge. I agree to give proof of the information that I have given on this form, if I am asked to do so. Failure to do so may be cause for denial and/or cancellation from the TRiO-SSS Program. Additionally, I authorize the TRiO-SSS Program to monitor my financial aid status and academic progress.

 

 
Sign and Submit:
Applicant Signature *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.