Thank you for your interest in ACHIEVE Program! Please complete this application as thoroughly as possible. You cannot save and restart this application. You may want to review the included items, 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 (573) 840-9650 or email achieve@trcc.edu.

To be considered for ACHIEVE, students must meet the following criteria:

Be a student of Three Rivers
Be a U.S. citizen or national of the U.S. or meet residency requirements for Federal student financial assistance
Have a need for academic support
Be a first-generation college student (neither parent has a bachelor’s degree) and/or meet family income guidelines OR be an individual with disabilities.

All applicants who meet the basic criteria will be evaluated to determine interest and placement in the program.

DEMOGRAPHIC INFORMATION

Last Name *

First Name *

Middle Name *

School ID *

TRC Student Issued Email Address *

Date of Birth *

Preferred Name

Gender *

Permanent Address *

Permanent City *

Permanent State *

Permanent Zip *

Permanent Phone *

Cell Phone Number *

Cell Phone Opt Out

Did you participate in Educational Talent Search? *

Name of High School Attended (GED or HiSET) *

Date of High School Graduation/GED/HiSet *

U.S. Citizen *

Permanent Resident *

Marital Status *

Ethnicity *

ELIGIBILITY

As a federally funded TRIO program, ACHIEVE is required to provide documentation of your eligibility for our program to the U.S. Department of Education in order to meet TRIO regulations that two-thirds of program participants must meet federal low-income guidelines and be first-generation.

All three sections under Eligibility must be completed for the application to be considered for the ACHIEVE Program.

First Generation College Student

Did you live in a single-parent/guardian household before turning 18? *

If yes, did that parent/guardian complete a 4-year degree? *

Two Parent/Guardian Households: Has either parent/guardian complete a 4 year degree prior to turning 18? *

Do any of the following apply: *

I have been an orphan, in foster care, or in the care of the courts
I am an emancipated minor or am in legal guardianship, as determined by the court.
Before age 24, I was homeless, as defined by the US Department of Housing and Urban Development.

Disability Eligibility

Do you have a documented disability as defined by the Americans with Disabilities Act? *

Are you currently registered with the Office of Disability Services? *

If you answered yes to having a documented disability, we strongly encourage you to contact the Office of Disability Services at disabilityservices@trcc.edu or 573-840-9605.

Income Verification

Dependent and Independent status definitions:

*Dependent students are typically younger than 24, unmarried and parental tax information is reported on the FAFSA.

*Independent students are typically age 24+, married, served in the U.S. military, has legal dependents other than a spouse, or was part of the foster care system/ward of the court since age 13, or classified as homeless.

Visit https://studentaid.gov/apply-for-aid/fafsa/filling-out/dependency for further clarification on independent vs. dependent status.

Are you considered dependent or independent according to your most recent FAFSA? *

Size of household inlcuding the applicant *

Please select household taxable income level from most recent tax year *

ACADEMIC NEED

This assessment is designed to explore the participant's expectations of college, the participant's prior education experience, and to determine how we can help.

Is preparing for tests/studying for tests a challenge? *

Do you feel anxiety when taking tests? *

Is it difficult for you to manage your time and/or be organized? *

Do you feel your computer skills could improve to assist you with online course work? *

Do you have consistent access to the internet and a computer for online courses? *

Do you feel you would benefit from tutoring? *

If selected yes to tutoring, please list subject areas

PROGRAM SERVICES

The following services are provided free to participants. Please indicate any that might be of benefit or interest.

University/ 4-year college information *

Campus visits to 4-year schools *

Assistance with application process to transfer *

WORKSHOPS

Financial Aid/Scholarship *

Financial Literacy/ Money Management *

Career Exploration/Finding a Major *

Time Management *

Stress Management *

Study Skills *

Resume Writing/Interview Prep *

Proffessional Skills *

Participation Agreement

The ACHIEVE Program provides comprehensive student support services designed to enhance academic success, retention, and student satisfaction. ACHIEVE Program has expectations of the students being served and participants have expectations of the ACHIEVE program. To be a successful experience, we must work cooperatively as a team.

To be a participant in good standing with ACHIEVE I am making a commitment to the responsibilities outlined below. I agree to:

Attend my classes regularly and on time and notify instructors of an absence or emergencies.
Consult with an ACHIEVE advisor before dropping any classes to avoid any Financial Aid eligibility consequences.
Meet with my ACHIEVE Academic Advisor at least once a semester to create/change my education plan that is aligned with my educational/career goals.
Use available tutoring services to strive to maintain good academic standing.
Complete career assessments with in the first semester of receiving ACHIEVE services.
Attend my scheduled appointments/and events with ACHIEVE and communicate with ACHIEVE when I cannot make these scheduled meetings/events.
Participate in a minimum of 2 ACHIEVE services per semester, options include seminars/workshops (face to face, live virtual, or on demand), tutoring, academic or career counseling/advising, financial aid assistance, or campus transfer visits.
Maintain regular communication with the ACHIEVE staff by reading and responding to e-mails, phone calls, and texts in a timely manner, stopping by the office or requesting virtual meetings.

Three Rivers College and the ACHIEVE Program agrees to provide the following services:

Free tutoring services
Educational, career, and financial counseling
Assistance in career exploration and planning
Transfer assistance to 4-year institutions
Free admission and transportation to select cultural/educational events and campus visits
Referral to other resources as needed

I understand that participation and/or acceptance into the ACHIEVE Program is contingent upon verification that I meet at least one of the following eligibility requirements

Be a first-generation college student (neither parent has a 4-year degree)
Meet federal income guidelines
An individual with a documented disability registered through the Office of Disability Services

Select a verification method and e-sign here *

Please select a signature verification type.

Student Signature

By signing below I certify that the information provided is true and complete to the best of my knowledge, I understand that ACHIEVE staff may contact me for clarification of information or relevant offices at Three Rivers College.

Confidentiality & Authorization for Records Release Agreement

In addition by signing below, I authorize Three Rivers College, its advisors, officers, instructors, etc. to release to the ACHIEVE Program Director and staff, information regarding my academic and financial records, this includes but is not limited to information on grades, grade transcripts, ACT/ GED scores, FAFSA records and related tax information, Needs Analysis and Grant /Aid Award Letters.

I understand that this information may be released by ACHIEVE to the Department of Education or other authorized entities in compliance with federal, state and local laws, rules and regulations.

I understand that a copy of this application and resulting information will be kept on file in the ACHIEVE Program Office and will be kept confidential in compliance with the Family Education Rights and Privacy Act.

Select a verification method and e-sign here *

Please select a signature verification type.

Photo Consent

I authorize Three Rivers College/ACHIEVE Program to photograph or film me and consent for the use of my likeness in any and all publications, educational materials, research, advertising, news media, video and internet (World Wide Web) materials. I acknowledge Three Rivers College’s right to crop or treat the photograph at its discretion. I further understand and agree that these materials may be kept on file and/or used by Three Rivers College for potential future uses and release the college from any and all liability arising from or in connection with the taking, use, publication or dissemination of such materials.

Select a verification method and e-sign here

Please select a signature verification type.

Photo Consent

I do not authorize Three Rivers College/ACHIEVE Program to photograph or film me and I do not consent to the use of my likeness in any and all publications, educational materials, research, advertising, news media, video and internet (World Wide Web) materials.

Select a verification method and e-sign here

Please select a signature verification type.

Income Verification Signature

Parent Signature (for Dependent Students) By signing below, I certify that the income verification information provided is true and complete, to the best of my knowledge. I understand that ACHIEVE may contact me for further clarification or reach out to other Three River College offices as needed.

Independent Students will sign in the space below certifying that the income verification information provided is true and complete, to the best of my knowledge. I understand that ACHIEVE may contact me for further clarification or reach out to other Three River College offices as needed.

Print Name of Parent/Guardian for Dependent Student( If Independent, type your name in the box and sign below *

Select a verification method and e-sign here *

Please select a signature verification type.

Three Rivers College is an equal opportunity institution that commits itself to the policy that there will be no unlawful discrimination against any person because of race, color, gender, sexual orientation, religion, age, disability, or national origin.