DCTC TRIO/Student Support Services

Thank you for your interest in the TRIO/Student Support Services program at Dakota County Technical College! Please complete this form and an advisor will be in touch with you. For help with this form, please contact Megan Petersen.

A screen reader-accessible version of this form can be downloaded here.


Basic Information
Tech ID or Star ID (if known)
I am a: *
Last Name *
First Name *
Preferred Name
Date of Birth *
Gender *
Cell Phone Number
DCTC Email Address
Personal Email Address *

Race/Ethnicity and Background Infromation

Please select "yes" for all race(s) that apply to you:

Native American or Alaska Native *
Asian *
Black or African American *
White *
Hawaiian or other Pacific Islander *
Hispanic/Latinx *
What language(s) do you speak?
With which cultural/national/tribal background(s) do you identify?
What is your citizenship status? *

TRIO Eligibility

Did the parent(s)/guardian(s) you lived with while in high school have a bachelor’s degree? *
Do you have a disability? *
If you have a disability, have you documented it with Accessibility Services?
Do you have a Bachelor or Master's Degree? *
What is your primary language?
Please provide your family's Adjusted Gross Income. If you are a dependent student, this will be on Line 15 of your parent's most recent tax return (IRS 1040 form). If you are an independent student, this will be on Line 15 of your or your spouse's most recent tax return (IRS 1040 form). If you or your parents did not file taxes, please type "no taxes filed."
Please provide your family size. Dependent students: Include your parents, yourself, and any siblings currently living at home. Independent students: include yourself, your spouse, and any dependent children you have.
Academic History and Goals
What are your educational goals at DCTC? *
What are your goals after DCTC? *
What is your intended area of study? *
Did you graduate from high school? *
Have you previously attended college? *
If you have previously attended college, where?
If you previously attended college, were you involved in TRIO/SSS or a similar program?
Have you participated in a college access program such as Upward Bound, College Possible, Educational Talent Search, AVID, etc.? If so, which program?

Academic Need Section:

What services are you interested in receiving from TRIO/SSS? Please check all that apply.

Academic Advising
Career Advising
College Success Seminars
Transfer Planning
Cultural Events/Activities
Financial Aid/Scholarship Planning
Peer Mentoring
Counseling/Social Navigation
Tutoring
Short Answer Section:
What brings you to DCTC? *
Why did you pick your major? *
What are your successes? *
Why do you think you were successful? *
What is/has been a challenge for you? *
What are your dreams? *
What about college makes you apprehensive? *
Do you have a job? If so: Where and how many hours per week do you work? *
What do you do for fun? *
What do you do to relax? *
How do you manage stress? *
Is there anything else you would like TRIO/SSS to know about you?
How did you hear about TRIO/SSS? *
If you would like to upload any documents related to your application, you may do so here.

INTAKE AGREEMENTS

Participant Responsibility Agreement

I understand that being in the TRIO Student Support Services Program is a privilege, and that I am accountable for my participation and progress. The Student Support Services staff will lend assistance and support, but I am responsible for my success.

As a Student Support Services participant, I agree to the following:
Minimum Requirements: 
Members are required to:
  • Attend weekly or every other week advising sessions; these may decrease if approved by SSS advisor. The minimum number of required check-ins for any student is 3 per semester. 
  • Attend at least 1 educational workshop or cultural activity per semester.
  • Complete the College Student Inventory.Complete a financial literacy module or session.

 General Responsibilities: 

  • Keep the SSS staff informed and up to date on my progress. 
  • Always maintain a “professional relationship” with SSS staff and tutors. 
  • Treat the SSS staff and fellow program participants with respect. 
  • Abide by the DCTC Code of Conduct as outlined in the Student Handbook. 
  • Notify SSS staff if I am unable to attend a scheduled appointment or event. 
  • Notify SSS staff if I withdraw from DCTC or transfer to another college.
  • Meet with my SSS program advisor BEFORE withdrawing from any class

I have read and understand my responsibilities as stated in this contract. I agree to the terms of this contract and will uphold them to the best of my ability. I realize that my failure to meet these responsibilities can result in dismissal from the Student Support Services program.

 

Authorization for Mulitple Releases

I authorize the staff of TRIO Student Support Services to gather and share information with those concerned about my academic progress, such as the Dean's office, instructors, counselors, financial aid, Disability Services, etc. 

 

Exception to Confidentiality

I understand that personal information will not be shared and will remain confidential unless TRIO Student Support Services is legally required to break confidence. These exceptions are as follows:

  • If there is reasonable cause to believe that you are a danger to yourself or others, it may be necesary to inform the appropriate people.
  • If we suspect abuse of children or vulnerable adults, we are required to notify the appropriate agencies.
  • If you are involved in certain criminal or civil proceedings, we may be required by court subpoena to release records and/or have staff testify. 

Student Publicity Release

I agree that if I am accepted into the TRIO Student Support Services program, the staff may include my name and/or photo in publications, including their website. The website highlights student accomplishments and participation in campus and program activities.

 

Accessibility Release of Information

I hereby give permission to the Office of Accessibility Services to release information about my disability to the Student Support Services program. This information will only be used to meet the requirements for the US Department of Education in qualify for the program, maintaining records, and providing the best possible services based in the specific needs of my disability/disabilities. 

 
I have read and agree to the Intake Agreements. *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.