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Thank you for your interest in the TRIO Student Support Services - ESL program at Kirkwood Community College!  Please complete this application as thoroughly as possible.  You cannot save and restart this application.  You may want to review the included items, take some time to make notes and gather the required documents, and then return to submit your application.  If you have any questions, please call our office at (319) 887-3602.


Personal Information
First Name *
Last Name *
Middle Name
knumber *
Home Address *
City *
State *
Zip *
Phone Number *
Is it okay if we text you at this phone number?
Email Address *
Gender
Race/Ethnicity (please check any that apply):
Hispanic or Latino
Black or African American
Native American
White
Asian
Native Hawaiian or Pacific Islander
Do you identify as any of the following?
Foster Child
Homeless
U.S. Veteran
Dislocated Worker
If you were not born in the US, what Country are you from?
If you were not born in the US, what year did you arrive in the US?
Are you a U.S. Citizen? *
Are you a Permanent Resident (Green Card)? *
Are you a non-native English speaker OR do you speak, read, write in another language at home OR are you enrolled in English Language Acquisition classes? (Note: If you are enrolled into ELA classes, you must be at least Level 5 to join TRIO).
What languages do you speak?

Academic/Educational Questions
Have you already earned a college degree? *
What amount of time do you plan to attend college?
When did you first start taking classes at Kirkwood?
Which campus are you primarily taking classes on? *
Are you currently enrolled in English Language Acquisition (ELA) classes? *
If YES, what level?
What is your major/program of study? *
Do you want to earn an Associate's Degree at Kirkwood? *
If NO, are you planning to earn a Diploma or Certificate?
Do you plan on transferring to a 4-year college/university? *

Eligibility Information
Are you a first-generation college student? (Neither parent or guardian has a four-year college degree) *
The term "low-income" means an individual whose family's taxable income for the preceding year did not exceed 150% of the poverty level amount. Please use the chart as a guide. (Income will be verified by TRIO staff.)

Size of Family Unit

Low Income Guidelines

1

$20,385

2

$27,465

3

$34,545

4

$41,625

5

$48,705

6

$55,785

7

$62,865

8

$69,945


Do you consider yourself low income? *
Do you have a disability? (i.e. physical, learning, mental health or other) *
If yes, is the disability documentation on file with Learning Services?
Are you currently in high school? *

Personal Statement
If you are able, please tell us about your educational and career goals that you have for yourself.
Type here:
Did anyone help you complete this application? *
If YES, who:

Signature
By signing this document, I authorize TRIO Student Support Services-ESL program staff at Kirkwood Community College to review my TRIO SSS-ESL application, admissions application, placement scores, academic record, transcripts, demographic information, financial aid reports, tax information, and GPA to determine my eligibility for the program. I also allow TRIO SSS-ESL to request, forward and/or share any/all personal information with other programs/offices as it relates to obtaining/verifying required documents and/or to refer me to other programs I may be eligible for.
Signature *
Signature Type: Simple    Start Over
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Signature: (Type in your full name)
I agree to the terms included.

 

The TRIO Student Support Services - ESL program is funded by the US Department of Education.