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CCV TRIO Student Support Services Program Application and Enrollment Form
You may be eligible for the
CCV TRIO Student Support Services Program
! This is a federally funded program designed to support students in reaching their academic potential and meet their educational and career goals. CCV TRIO can serve a limited number of students, therefore we have an application process that assesses student motivation, academic need, and ability to benefit. The selection process also includes a conversation with a TRIO Advisor, which can be scheduled by calling your local CCV Center.
CCV TRIO students are typically eligible to receive the following benefits for up to four years or until graduation or transfer:
Priority advising with a TRIO academic advisor who will partner with you to explore your academic and career interests and goals. Life coaching with a dedicated TRIO coach.
Eligibility to participate in TRIO’s Tech-to-Go (technology lending) program.
Participation in Annual Leadership Day and other leadership development opportunities.
Opportunity to apply for specific TRIO grants ($700 to $1000).
Individual tutoring when you need instruction beyond what Tutor.com can provide.
Financial Literacy instruction to support your financial goals and money management.
College visits, workshops, transfer, and career information.
Eligibility for CCV TRIO Study Abroad Scholarships (two $500 scholarships) awarded annually.
Free access to Clifton Strengths for personal and career development.
Being a student is hard work, as you already know, and this program is one more resource in your effort to earn a college degree.
Acceptance to CCV’s TRIO program is an honor and takes a commitment by the student to be truly effective.
Your responsibilities as a student of TRIO include:
Completing a Student Success Plan with a goal of degree completion within 4 years
Meeting with your advisor two times per semester
Work in partnership with your TRIO coach
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If you check "Yes" to
one or more
of these questions, you are eligible to apply for the TRIO program.
Neither of my parents earned a Bachelor's (4-year) Degree before I started college.
Neither of my parents earned a Bachelor's (4-year) Degree before I started college.
Yes
No
I am eligible for Pell Grants as part of my Financial Aid package.
I am eligible for Pell Grants as part of my Financial Aid package.
Yes
No
I am student with a documented disability.
I am student with a documented disability.
Yes
No
TRIO is currently available in the following CCV centers:
Bennington
Montpelier
Morrisville
Newport
Rutland
St. Albans
St. Johnsbury
Winooski
Please choose your CCV TRIO location
Bennington
Montpelier
Morrisville
Newport
Rutland
St. Albans
St. Johnsbury
Winooski
In order to be eligible for TRIO Support Services, you must either be a first generation student, Pell Grant eligible or a student with a documented disability. Please contact your local CCV center to ask what services and supports are available to you.
Complete the form below to apply for the TRIO Student Support Services Program.
All fields marked with a "*" are required to complete the application
Contact Information
First Name
Middle Name
Last Name
Preferred Name (if different than first name)
Birthdate
Birthdate
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Email Address
Phone Number Type
Email Address
Phone (Mobile / Text Me)
Phone (Mobile / No Text)
Phone (Home / Land Line)
Phone (Work)
Mobile Phone Number
Home Phone Number
Mobile (No Text) Phone Number
Academic Information
CCV Degree Program
Accounting
Behavioral Science
Business
Design & Media Studies
Early Childhood Education
Environmental Science
Health Science
Information Technology
Liberal Studies
Liberal Studies: Global Studies Concentration
Professional Studies
STEM Studies
Undeclared Major
Afterschool & Youth Work Certificate
Allied Health Sciences Preparation
Bookkeeping
Childcare
Clinical Medical Assisting
Cloud Computing
Community Health
Cybersecurity and Networking
Digital Marketing
Digital Media Production
Early Childhood Education Administrator
Entrepreneurship
Funeral Director
Graphic Design
Human Resource Management
Human Services
IT Support
Leadership Skills
Media Communications
Medical Billing & Coding
Pharmacy Technician
STEM Studies Certificate
Studio Art
Web Development
Workplace Skills
Continuing Education
Dual Enrollment
Early College
Your current Academic Advisor
Darcy Oakes, dlo01090@ccv.vsc.edu
Shelley Adriance, sxa03251@ccv.vsc.edu
Leigh Marthe, lcm02280@ccv.vsc.edu
Zachary Young, zsy03250@ccv.vsc.edu
Suzanne Buck, Suzanne.Buck@ccv.edu
MK Dreher, mary.dreher@ccv.edu
Regan Christie, regan.christie@ccv.edu
Billi Dunham, bjf09020@ccv.vsc.edu
Justin Bourdeau, jsb08112@ccv.vsc.edu
Sally McCarthy, sally.mccarthy@ccv.edu
Eliza Walters, ejw03020@ccv.vsc.edu
Sarah Corrow, sec10090@ccv.vsc.edu
Erik Zetterstrom, edz06040@ccv.vsc.edu
Nathan Astin, nba05220@ccv.vsc.edu
Tammy Howard, tmh10110@ccv.vsc.edu
Cody Miller, cxm03080@ccv.vsc.edu
Leigh Marthe, lcm02280@ccv.vsc.edu
Zachary Young, zsy03250@ccv.vsc.edu
Joanne Cotignola, jcc07150@ccv.vsc.edu
Kerri Brooks, klb02090@ccv.vsc.edu
Tana Randall, tvr03190@ccv.vsc.edu
Conner Gilbert, cmg01250@ccv.vsc.edu
Tina Despins-Prescott, tap10110@ccv.vsc.edu
Erin Wetherell, emw06080@ccv.vsc.edu
Kelly Craig Stoner, kelly.stoner@ccv.edu
Amy Stuart, aes09140@ccv.vsc.edu
Dave Amsden, dma06280@ccv.vsc.edu
Ian Boyd, isb08200@ccv.vsc.edu
Marie Frietze, mrf05230@ccv.vsc.edu
Tuipate Mubiay, txm02140@ccv.vsc.edu
Tana Randall, tvr03190@ccv.vsc.edu
I am not sure who my advisor is
Personal Information
Please check all that apply.
I am...
Please check all that apply.
I am...
Veteran/Active Duty Military/Guardsmember
Post Secondary Education Participant (through Reach Up)
Foster Child
Homeless
English Language Learner (ESL/ELL)
If ESL/ELL, what is your first language?
What is your citizenship status?
United States citizen
US National or meet the residency requirement for federal student financial aid
None of the above
What is your ethnicity? (check all that apply)
What is your ethnicity? (check all that apply)
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Individual Needs Assessment
Please check all that apply to you.
Academics
Academics
I am unsure that high school prepared me for college and/or I earned low high school grades.
I have earned or I am earning low grades in college.
I have achieved a GED.
I am concerned about my math or writing skills.
I am inexperienced with study strategies that work for me.
It has been more than five years since I have been in high school.
Major/Career/Transfer
Major/Career/Transfer
I would like information and assistance for transferring to a four-year school
I would like to visit four-year schools to take campus tours and to better understand the transfer process
I am uncertain about my future career and/or which majors would be a good fit for me
Personal
Personal
I plan to work over 20 hours a week and attend school full time.
I have significant family responsibilities (children, siblings, parents).
I have significant financial responsibilities outside of school costs.
Anything else you would like to share about your academic goals or needs?
The information you provide is strictly confidential and is necessary for reporting purposes as well as eligibility determination
.
Each TRIO SSS student’s individual performance impacts the entire program; therefore, each TRIO SSS student must agree to act responsibly and to be accountable for attainment of educational goals. CCV’s Student Support Services TRIO program is federally funded under the Department of Education.
By typing my name below, I give permission for TRIO staff to access or verify any information provided on this document. (The federal government requires that TRIO/SSS have on file documentation of taxable income, such as federal tax forms or a Student Aid Report from FAFSA, for all students admitted to the program.) I attest that the information given on this application is correct to the best of my ability.
Signature (Type Full Name)
HIDDEN: Today's Date
HIDDEN: Today's Date
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