ODEI Student Support Programs Application

Student Support Programs

Please select the program(s) you are interested in joining.

Student Support Programs
Contact Information
Applicant Information
Are you a current GRCC Student?
Have you already taken CLS 100?
Were/Are you required to take: (check all that apply or skip this question if it doesn't apply)
Are you a first generation college student?
Are you a DACA or Undocumented Student? (This is only for the program staff to know how to best serve your needs and to find resources for your success. Your answer is confidential and will not be reported to any organizations or entities.)
Please indicate how you identify racially/ethnically
Please indicate how you identify racially/ethnically
What are your educational goals: (check all that apply)
Short Answer Questions
Please respond to the following questions. If you need additional space, please attach a document.
Upload requirements
Signature

Student Clearance and Approval

I understand that by signing this form, the information I provided is accurate to the best of my knowledge. My signature will serve as my indicated commitment to the selected Student Support Program(s) at GRCC. I understand that I must participate in the summer immersion program (20 hours during one week), as well as, the other program offerings in order for me to receive the full benefits of the program.

I understand that the indicated Student Support Program(s) of interest will use information for educational purposes only.

I am authorizing the indicated Student Support Program(s) of interest to share and/or obtain information from the registration, advising and counseling, financial aid office, instructors, administrators, student life office, and any other relevant GRCC staff or faculty person who has a vested interest in my academic success and overall well-being.

Signature