TRIO Talent Search Application - Dodge City Community College

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Best Time to Call

Email *

Someone who can always receive your mail or be contacted in an emergency *

First

Middle

Last

Race (Indicate all that apply)

American Indian or Alaskan Native
Asian
Black or African-American
Hispanic or Latino
Native Hawaiian or other Pacific Islander
White
Other

If you chose Other, please specify here

Eligibility

What Country were you born in?

Are you a U.S. Citizen or permanent resident?

If you are a permanent resident, please provide your alien registration number

Has either parent completed a four-year Bachelor's degree?

Are you living with that parent?

Do you have a documented disability?

Yes (including if you had an IEP in high school)
No

Have you applied for Financial Aid?

Are you receiving the Pell Grant?

Educational Information

What grade are you currently in?

What school are you currently attending?

Have you completed ACCUPLACER Testing?

Completed ACT testing?

Do you have a high school diploma?

Yes
or a GED?
No

Date received

Name of high school

Expected high school graduation date

What is your educational objective? (check all that apply)

No definite purpose in mind
To obtain a vocational A.A.S. degree
To take a job-related course
Future plans to attend high school
To take courses to transfer
To complete a certificate
To obtain an Associates Degree and then transfer to a 4 year univiersity

Dual Enrollment (check all that apply)

Dual Credit
Advanced Placement
Concurrent Enrollment
STEM Programs
Accelerated Placement

Other

In your own words, please explain briefly why you want to participate in the TRIO Talent Search Program

Services Available

Please check all program services you are interested in

college campus visits
earning good/better grades
tutoring services and referrals
managing my learning difficulties
exploring careers/selecting a career
academic advising assistance in course planning and selection
workshop opportunities (specify topic of interest below)
deciding on a major
overcoming test anxiety/becoming a better test taker
meeting with the same academic advisor
using the TRIO Support Center/Computer Lab
assistance transferring to a 4 year school
assistance completing college admission applications
financial aid application/FAFSA assistance

Other assistance you would like to receive

Authorization

I authorize the TRIO Talent Search Program to obtain, copy, review, and discuss records with DCCC faculty and staff including:

High School Transcript
Transcripts from other colleges
Financial Aid records
Standardized test scores
Most recent SIGNED copy of Federal Tax Form 1040
Course registration for each semester
Academic progress
Final grades and transcripts
Disability Documentation
Travel permission for my minor child on TRIO trips

1040 Taxable Income (Line 15)

Household size

Student Signature

Date

Parent/Guardian Signature

Date

TRIO Talent Search Program Dodge City Community College 620-227-9296 This is a funded publication by the U.S. Department of Education (Grant #P044A210400) Your privacy is important to us. Please send application and supporting documentation to our secure file link: https://liquidfiles.dc3.edu/filedrop/groberts