Perkins Student Support Services Application

Trinity Valley Community College

Perkins Student Support Application
Date*

MonthDayYear
Date
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
TVIN/Student ID*
Gender*

MaleFemale
Campus Location:*

AthensKaufmanPalestineTerrell HSCTerrellOther
Major/Degree*
Number of hours enrolled*

Full time (12+ hours)Part time (3-11 hours)
Are you currently receiving financial aid assistance?*

YesNo
I am receiving, or will be receiving, the following financial aid assistance (check each box that applies).

Pell GrantVA benefitsTEC/TRACCMSSEOGTexas RehabTPEGOther
Within the past year, have you been out of work to serve as a primary homemaker or caretaker?*

YesNo
I am out of work due to:
I am part of, or have been part of the foster care system.*

YesNoPrefer not to answer
Within the past 12 months, have you experienced homelessness or housing insecurities.*

YesNoPrefer not to answer
I am a single parent or a single pregnant woman.*

YesNoPrefer not to answer
My parent is a member of the armed forces and is on active duty.*

YesNoPrefer not to answer
Are you learning English as your second language?*

YesNoPrefer not to answer
Do you identify as a person with a disability or other chronic condition?*

YesNoPrefer not to answer
Please check all the services you are applying for through Perkins Student Support Assistance Application:*

Computer Loaner Program - LaptopMiFi Hotspot LoanerChildcare Assistance (Infant to 12 years old)Textbooks and/or other required course materials (Access codes, ATI resource fee)Transportation Assistance (distance of 20 miles or more roundtrip to campus)Court Reporting Stenograph Equipment Loaner
Attach a screen shot of your degree plan from MyCardinalConnect under Student Planning/My Progress that includes Name, TVIN, Major, all courses enrolled, and GPA. *

(See Sample image below)
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Upload a screen shot FAFSA completion.

Below is a sample that provides proof of FAFSA submission.
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Upload a screen shot of your class schedule. Must show days of the week attending and the location.

(Online courses are not eligible for transportation assistance)
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Upload a Map from your home to the location you are attending. The total mileage must be at least 20 miles round trip to be eligible for transportation assistance. (google maps, map quest, apple maps, etc.)

IF you are attending clinicals please upload a map for each location. (Home to Campus, Home to Clinical site 1, Home to Clinical site 2)
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In additon to the services provided by the Workforce Education Department in this application, we would like you to be aware of the other services provided by TVCC.

Academic Coaching Sessions: (meet anytime with academic coach for personal one-on-one meetings to help improve learning skills and performance.)

Advocacy Resource Center: (provides a free food pantry and clothes closet which includes but is not limited to food, personal hygiene items, school supplies, bedding, towels, and various clothing items.)

Cardinal Mentor Program: (providing support of students who have non-academic struggles life challenges such as, trying to juggle all their responsibilities, job stresses, money struggles, etc.)

Cardinal Success Center: (gain motivation to reach academic goals; connect with peers, mentors, and tutors for help.)

Free Tutoring: (online and face-to-face)

Student Access Services: (for students needing reasonable accommodation to assist in meeting educational goals; services for emotional support and disability needs.)

Student Mental Health Counseling: (provides brief, solution-focused counseling for students who are facing personal difficulties)
Please select all service which you would like to receive additional information.

Academic Coaching SessionsAdvocacy Resource CenterCardinal Mentor ProgramCardinal Success CenterFree Tutoring: (online and face-to-face)Student Access ServicesStudent Mental Health Counseling
Signature*

Clear
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Trinity Valley Community College