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SMCC TRIO SSS Student Referral Form
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* Indicates required question
Your first, last name
*
Your answer
Your telephone number
*
Your answer
Your email
*
Your answer
I am a . . . (check all that apply)
*
SMCC faculty/staff member
Current TRIO SSS student at SMCC
High school staff member
Upward Bound staff member
Talent Search staff member
EOC staff member
Other
Required
First, last name of student you are referring
*
Your answer
Student ID number
Your answer
In what ways do you think TRIO could help this student?
*
Transfer and/or Career planning
Connection to academic resources
Other (please specify)
Required
Do you have reason to believe that the student meets any of these criteria?
*
First Generation
Low Income
Disability
Not Sure
Required
If Disability is checked, does the student plan on registering with Disability Services?
Yes
No
Maybe
Clear selection
Does the student know they are being referred?
*
Yes
No
What is the best way to contact the student?
Email
Phone
Text Message
Clear selection
Best email for Student
*
Your answer
Best phone number for Student
*
Your answer
Please feel free to share any additional information here
Your answer
Submit
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