Thank you for your interest in our TRIO Student Support Services program!

Please complete this application as thoroughly as possible. Note that you cannot save and restart this application. If you have any questions, or any difficulties in completing this application online, please email our office at TRIO@berkshirecc.edu. We will send you a PDF application.

General Information:

Last Name *

First Name *

Middle Name

School ID (without the "s") *

How did you hear about TRIO? *

Address *

Apt number:

City: *

State: *

Zip Code *

Primary Phone Number: *

BCC Email (s + student ID@berkshirecc.edu) *

Alternate Email

Demographics Information:

Date of Birth (MM/DD/YYYY) *

Sex Assigned at Birth: *

Which gender identity do you self-identify with?

Hispanic/Latino(a) descent: *

Ethnicity/Race: you must answer "yes" to one of the following choices:

American Indian or Alaskan Native *

Asian *

Black or African American *

White *

Native Hawaiian or Other Pacific Islander *

Eligibility Information:

Are you enrolled in at least 6 credits? (Yes/No) *

Are you a U.S. Citizen or Permanent Resident? *

Did either parent living with you while you were a teenager (up to 18 years of age) graduate with a Bachelor from a 4 year College or University? *

Do you have a documented disability on file in the BCC Disability Resource Center? *

How many people live in your household?

If your family lives in Alaska or Hawaii, choose yes and continue the application without entering any more financial information

If you know, indicate your family's taxable income range:

Academic Information:

What is your most important academic need? *

Date, Sign or Initial, and Submit:

Applicant Signature. Enter today's date, and sign. If you have trouble signing, just write in your initials.

Date: *

Sign: *

Signature Type: Simple Start Over

Signature: (Type in your full name)

I agree to the terms included.

Once signed & submitted, scroll to the bottom to submit application.

Terms: By submitting this application, you acknowledge that all of the above information is correct and accurate to the best of your understanding.

Statement of Non-Discrimination: Berkshire Community College is an affirmative action/equal opportunity institution and does not discriminate on the basis of race, creed, religion, color, gender, sexual orientation, age, disability, genetic information, maternity leave, and national origin in its educational programs or employment pursuant to Massachusetts General Laws, Chapter 151B and 151C, Title VI, Civil Rights Act of 1964, Title IX, Education Amendments of 1972, Section 504, Rehabilitation Act 0f 1973; the Americans with Disabilities Act, and regulations promulgated thereunder, 34 C.F.R. Part 100 (Title VI), Part 106 (Title IX), and Part 104 (Section 504). All inquiries concerning application of the above should be directed to Melissa Loiodice, Director of Human Resources abd Affirmative Action Officer, and Coordinator of Title IX and Section 504; located in the Susan B. Anthony Center Annex, Room A20, at 413-236-1022. The Commonwealth of Massachusetts Community Colleges’ Affirmative Action Plan, which is available in the Human Recourses Office, contains a full explanation of this specific policy.

TRIO Application, Berkshire Community College

I authorize release of information from my financial and/or academic record as requested by the TRIO Program or as needed by Federal, State or Financial Aid organizations for any legitimate purpose. I also authorize the TRIO staff to verify disability documentation with the Coordinator of the Disability Resource Center, if applicable. In addition, I give TRIO permission to talk to others who are directly involved in my education for the sole purpose of assisting me in the pursuit of my educational objectives. Faculty, Tutoring, all TRIO staff, Academic Advising, Financial Aid, Counseling Services, Disability Services, and Student Billing are examples of some of the professionals that we may collaborate with in helping you achieve your goals. I understand that any related information will remain confidential and will be used only to:

1. establish eligibility for special services;

2. assess my academic progress and need for services;

3. meet program and federal reporting requirements;

4. obtain admissions/transfer information;

5. obtain college/university-tracking information.

I understand that TRIO’s purpose is to increase the retention, graduation, and transfer rates of program members, and agree to participate in related servicesuntil I meet my educational goals.