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Rogue Community College
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UNIVERSITY TRANSFER
TRIO/STUDENT SUPPORT SERVICES
2021-2022

*All form fields are required

Registration Form

Step 2: In order to process your application, you must answer every question and sign the signature line. For program services, you must have tested out of, completed, or be currently enrolled in MTH65 or MTH96, and WR115.



My first language is:



(If so, where )


If not in the list select other and type in text box.
If other:
Which University:



Which Program:








Other:
Program Eligibility:

Participants must meet at least ONE of the following eligibility requirements: low income, first generation, or a documented disability. In addition, ALL program participants must show academic need and the ability to earn a bachelor's degree. Please note that your intention must be to transfer to a four-year institution and NOT another community college to be eligible for this program.

Academic Need Eligibility

As determined by academic records and responses below



Distance (round trip)?


If yes, how many?


If yes, hours per week?
Program Eligibility:


Resident Alien#:



Release of Information:
I understand that by applying for the University Transfer TRIO/SSS program:

  • I authorize University Transfer TRIO/SSS staff to obtain records or data pertinent to my participation from other sources, and to release information, as required by law or the terms of the Student Support Services grant at RCC, and to other sources.
  • University Transfer TRIO/SSS staff has my permission to communicate verbally or otherwise with staff, faculty, and/or off-campus professionals on my behalf.
  • I grant Rogue Community College permission to release the following information to the RCC University Transfer TRIO/SSS program for the purpose of academic and personal advising and program documentation requirements: Academic records, financial aid records, disability documentation, and statistical data from educational agencies affiliated with RCC.
  • I grant University Transfer TRIO/SSS permission to track my past records and my future educational progress at other institutions and to release my academic and TRIO information if requested by another institution.

By typing my name I certify that the information I have provided on this application is complete and correct to the best of my knowledge.

Student Signature:

If you are human, leave blank

The TRIO Student Support Services program at Rogue Community College is funded by 2 federal TRIO grants that average $278,307 a year.