TRiO/SSS P&A


Participation and Acceptance Agreement Congratulations and welcome to TRiO Student Support Services at UCC. To ensure that you will benefit from our program and services, it is important that you understand our commitment to you as well as your role and responsibilities as a participant. TRiO/SSS will work closely with you in providing academic and career advising, academic tutoring, transfer assistance, and guidance on many other aspects of college. PARTICIPANT RESPONSIBILITIES: As a benefit, our students are potentially eligible for supplemental grant aid if they receive a Pell Grant, have unmet need, and a high loan burden. Additionally, TRiO/SSS has a library of books to loan out to students on a term-by-term basis to save on the cost of education. Students who fail to meet the responsibilities listed below will not be awarded supplemental grant aid, may not be able to attend trips, or receive book resources. As a participant in TRiO/SSS at UCC, I agree to the following responsibilities: Please initial on the lines below that you have agreed to.
First Name *
Last Name *
1. *I will participate in FREE non-credit first year experience workshops/events,* workshops on Transition to University, roundtables on financial literacy, and discussions on navigating college. I will also commit to at least one contact per term with a program staff member and/or participate in program activities. Midterm check-ins are required.
Initial *
2. If I am on academic probation or suspension I will be required to make a plan for success with my TRiO/SSS advisor and follow that plan. Regular meetings will be scheduled to ensure my success.
Initial *
3. I agree to attend all scheduled appointments. This includes tutoring. If I can’t make it to an appointment I will call in advance and let the appropriate staff know.
Initial *
4. I will contact the appropriate program staff before making changes in my educational plan to include my class schedule, contact information, and program of study. I will also inform Registration and Financial Aid of any changes.
Initial *
5. I agree to check my Educational Plan and my Degree Audit before registering for my courses. I will do my best to register as soon as I can.
Initial *
6. In the interest of academic success, I agree to attend class, interact with my instructors and communicate with them regularly. If I miss class, I will contact my instructor(s) directly to follow up on any missed work or information.
Initial *
7. I will discuss with a TRiO/SSS staff member any concern that may affect my educational success.
Initial *
8. I will do my best to complete enough credits per term to graduate within 4 years of joining TRiO/SSS. I will also strive to maintain at least a 2.75 GPA and if I fall below that I will meet with my TRiO/SSS advisor to make a plan for my success.
Initial *
9. I understand that TRiO/SSS communicates regularly regarding a variety of topics including: scholarships, financial aid, registration, transfer, and other important information. I will check my student email and texts regularly and will respond as needed.
Initial *
10. I will submit my FAFSA during the first week it is open, and I will complete a UCC and OSAC general scholarship application for each year I plan on attending.
Initial *
11. I know failing to participate, not making scheduled meetings, and not working toward my educational goals may put me at risk of becoming ineligible for TRiO/SSS supplemental grant aid, trips, and the textbook lending library.
Initial *
I understand that these services are designed to help me succeed and achieve my stated educational goals. I accept the invitation to participate in TRiO/SSS and understand the requirements, and agree to the responsibilities as a participating student. If I have any concerns about these requirements, I understand that I may discuss my concerns with a TRiO/SSS staff member.
Sign Here: * Please select a signature verification type.
Release of Information and Photograph Release Academic Release of Information: I understand that all information in my file is confidential and will not be released to any unauthorized individuals (including family members) without my written consent. I further understand that the program may release information from my file (in compliance with the Family Educational Rights & Privacy Act of 1974-FERPA) to college personnel who have a legitimate interest, at the direction of a court, or in emergency situations. I will familiarize myself with the student educational records section of the UCC catalog so that I know my student rights. Furthermore, if I am working with an outside agency, I will sign a specific release of information so that TRiO/SSS staff can communicate with that agency on my behalf, if I so choose.
Consent and Release to Photograph/Record: I hereby authorize Umpqua Community College, its District, Board of Directors and its employees (UCC), or persons hired by UCC to photograph, record, tape, film, or electronically capture in permanent form my name, likeness, image, voice, biographical and personal information, appearance and/or performance, and/or further to use and publish my writing(s) (collective work). I further grant UCC full permission to edit my writings and the original footage, data, voice or image as shall be deemed necessary; that the work and my name may be used, published and distributed without remuneration to me in whole or in part for educational, instructional or promotional purposed in print or over open broadcast, cable, audio-visual, radio, closed-circuit exhibition, computer like, or other medium for college purposes as deemed appropriate by UCC in perpetuity, throughout the world. For these purposes, I waive and relinquish my personal rights, privacy rights and rights under the Family Education Rights, Privacy Act and student records law of the state of Oregon. I hereby waive all rights to any claim for royalties or other payments. Said work and all components thereof shall become the property of UCC and may be copyrighted in its own name or a name of its choosing. I also release UCC from any and all claims of libel, slander, invasion of privacy or other claims based on my appearance and/or performance or use of the recording of such and agree to hold UCC harmless from any and all claims by the Third Parties, including any claim based on allegations of copyright infringement from my appearance and/or performance.
Sign Here: Please select a signature verification type.

Participation and Acceptance Agreement

Congratulations and welcome to TRiO Student Support Services at UCC. To ensure that you will benefit from our program and services, it is important that you understand our commitment to you as well as your role and responsibilities as a participant. TRiO/SSS will work closely with you in providing academic and career advising, academic tutoring, transfer assistance, and guidance on many other aspects of college.

PARTICIPANT RESPONSIBILITIES:

As a benefit, our students are potentially eligible for supplemental grant aid if they receive a Pell Grant, have unmet need, and a high loan burden. Additionally, TRiO/SSS has a library of books to loan out to students on a term-by-term basis to save on the cost of education. Students who fail to meet the responsibilities listed below will not be awarded supplemental grant aid, may not be able to attend trips, or receive book resources.

As a participant in TRiO/SSS at UCC, I agree to the following responsibilities:
Please initial on the lines below that you have agreed to.

First Name *

Last Name *

1. I will participate in FREE non-credit first year experience workshops/events, workshops on Transition to University, roundtables on financial literacy, and discussions on navigating college. I will also commit to at least one contact per term with a program staff member and/or participate in program activities. Midterm check-ins are required.

Initial *

2. If I am on academic probation or suspension I will be required to make a plan for success with my TRiO/SSS advisor and follow that plan. Regular meetings will be scheduled to ensure my success.

Initial *

3. I agree to attend all scheduled appointments. This includes tutoring. If I can’t make it to an appointment I will call in advance and let the appropriate staff know.

Initial *

4. I will contact the appropriate program staff before making changes in my educational plan to include my class schedule, contact information, and program of study. I will also inform Registration and Financial Aid of any changes.

Initial *

5. I agree to check my Educational Plan and my Degree Audit before registering for my courses. I will do my best to register as soon as I can.

Initial *

6. In the interest of academic success, I agree to attend class, interact with my instructors and communicate with them regularly. If I miss class, I will contact my instructor(s) directly to follow up on any missed work or information.

Initial *

7. I will discuss with a TRiO/SSS staff member any concern that may affect my educational success.

Initial *

8. I will do my best to complete enough credits per term to graduate within 4 years of joining TRiO/SSS. I will also strive to maintain at least a 2.75 GPA and if I fall below that I will meet with my TRiO/SSS advisor to make a plan for my success.

Initial *

9. I understand that TRiO/SSS communicates regularly regarding a variety of topics including: scholarships, financial aid, registration, transfer, and other important information. I will check my student email and texts regularly and will respond as needed.

Initial *

10. I will submit my FAFSA during the first week it is open, and I will complete a UCC and OSAC general scholarship application for each year I plan on attending.

Initial *

11. I know failing to participate, not making scheduled meetings, and not working toward my educational goals may put me at risk of becoming ineligible for TRiO/SSS supplemental grant aid, trips, and the textbook lending library.

Initial *

I understand that these services are designed to help me succeed and achieve my stated educational goals. I accept the invitation to participate in TRiO/SSS and understand the requirements, and agree to the responsibilities as a participating student. If I have any concerns about these requirements, I understand that I may discuss my concerns with a TRiO/SSS staff member.

Sign Here: *

Please select a signature verification type.

Release of Information and Photograph Release

Academic Release of Information:
I understand that all information in my file is confidential and will not be released to any unauthorized individuals (including family members) without my written consent. I further understand that the program may release information from my file (in compliance with the Family Educational Rights & Privacy Act of 1974-FERPA) to college personnel who have a legitimate interest, at the direction of a court, or in emergency situations. I will familiarize myself with the student educational records section of the UCC catalog so that I know my student rights. Furthermore, if I am working with an outside agency, I will sign a specific release of information so that TRiO/SSS staff can communicate with that agency on my behalf, if I so choose.

Consent and Release to Photograph/Record:
I hereby authorize Umpqua Community College, its District, Board of Directors and its employees (UCC), or persons hired by UCC to photograph, record, tape, film, or electronically capture in permanent form my name, likeness, image, voice, biographical and personal information, appearance and/or performance, and/or further to use and publish my writing(s) (collective work). I further grant UCC full permission to edit my writings and the original footage, data, voice or image as shall be deemed necessary; that the work and my name may be used, published and distributed without remuneration to me in whole or in part for educational, instructional or promotional purposed in print or over open broadcast, cable, audio-visual, radio, closed-circuit exhibition, computer like, or other medium for college purposes as deemed appropriate by UCC in perpetuity, throughout the world. For these purposes, I waive and relinquish my personal rights, privacy rights and rights under the Family Education Rights, Privacy Act and student records law of the state of Oregon. I hereby waive all rights to any claim for royalties or other payments. Said work and all components thereof shall become the property of UCC and may be copyrighted in its own name or a name of its choosing. I also release UCC from any and all claims of libel, slander, invasion of privacy or other claims based on my appearance and/or performance or use of the recording of such and agree to hold UCC harmless from any and all claims by the Third Parties, including any claim based on allegations of copyright infringement from my appearance and/or performance.

Sign Here:

Please select a signature verification type.