Student Support Services /  Project Success Application

Please note that this information will be submitted via non-secure e-mail.  Please do not send your Social Security Number or other information that you would not want someone else to know.  Individuals under the age of 13 should not use this form.

 

Project Success is a federally funded Student Support Services TRIO program that is designed to improve the retention, transfer, and graduation rates of the 150 low-income, first-generation, or disabled college students whom we serve.

Project Success accepts all students who are seeking an associate’s degree; however, preference will be given to students who intend to transfer to a 4-year college or university.

 

Please use the "Tab" key on your keyboard to move from one field to the next.















Emergency Contact name:

Telephone Number:



AA
AS
AAS
Certificate



Yes
No


1.
2.


Yes
No


Reading
Writing
Math
Chemistry

 

The Federal Government REQUIRES Project Success Participants to file a FAFSA for Federal Financial Aid. Even if you aren’t eligible for Federal Financial Aid, you may be eligible for Project Success. If you don’t apply for financial aid, you cannot participate in Project Success.


Yes
No, I need help with the forms
No, I plan to apply by (insert date)
No, I do not want to apply

 

To the best of your knowledge, indicate the highest level of education completed by your parent(s) or legal guardian(s) by the time you reached the age of 18.

 

Highest Level of Education
  Father Mother

Participation Information

Will you participate in Project Success sponsored events and workshops?
Yes
No


Yes
No
If yes, which one(s)?

Would you be interested in having a peer mentor?
Yes
No

Academic Advising
Career Exploration
Cultural Events
Disability Services
Early Registration Workshops
Financial Assistance/Scholarships
Other
Personal Counseling
Single Parent Information
Transfer Information
Tutoring/Study Skills
Wellness Club

 

Optional Information


Poster/Advertisement
Faculty/Staff
Counselor
Another Student whose name is
Other


American Indian/Alaska Native
Hispanic/Latino
Asian/Pacific Islands
White/Caucasian
Native Hawaiian/Other Pacific Islander
Black/African American
Other, Please Specify


Male
Female


Yes
No


Yes
No


Yes
No


Yes
No (If yes, you will need to provide documentation)


 

IVCC provides equal opportunity and affirmative action in education and employment for all qualified persons regardless of race, color, gender, sexual orientation, national origin, age, disability, religion, veteran status or any legally protected classification and it complies with Section 504 of the Rehabilitation act of 1973.

 

Please note that this information will be submitted via non-secure e-mail.  Please do not send your Social Security Number or other information that you would not want someone else to know.  Individuals under the age of 13 should not use this form.