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TRIO SSS Application

Tell Us About Yourself
ALL FIELDS ARE REQUIRED
Last Name
First Name, MI
 
Los Rios Student ID #
Street Address
City
ZIP
Los Rios Gmail email: Primary Phone
How did you Learn about Program?
   
Demographic information
Date of Birth (mm/dd/yyyy) Gender
Race/Ethnicity:
Multi-Ethnic or more than one ethnicity:
Do you currently serve in the military or have you ever served in the military?
   
Educational Information
Year of High School Graduation/GED
Is English your second Language?
  If yes, what is your primary language:
How many units are you enrolled in right now?
Which semester and year did you first enroll at ARC?
How many college units have you completed to date?
Current GPA:
What is your major at ARC? (if undecided, please state)
What is your college educational goal? (Check all that apply)
   Certificate 2 Year Degree Transfer to 4 Year Undecided
Have either of your parents graduated from a 4 year college?
Please list the highest grade completed by:
   Father Mother
Do you have any verified physical or learning disabilities that may affect your ability to be successful in college?
  If yes, please explain:
  If yes, have you applied to the Disabled Students Program?
   
Financial Aid Information  
Do you have a BOG fee waiver for this school year?
Have you applied for FAFSA?
What is your family's yearly taxable income?
What is the number of family members living at home?
   
Residency Status  
Are you a U.S. Citizen or National?
  If not, are you a permanent resident (you hold a green card)?
 
Special Program Information
Are you currently a participant of any other program on campus?
   VRC CARE DSPS EOPS Puente
   Other Specify:
   
By entering their name in the field below, the applicant agrees that they are providing an electronic signature that certifies that the information provided is accurate and true. The applicant also agrees to provide proof of the above information upon request. The applicant understands that their acceptance to the Student Support Services Program depends on the accuracy of the above answers.
Name Date