This form will help us determine your eligibility for the Services for Academic Success program. Services for Academic Success (SAS) is a federally-funded TRIO program supported by a grant from the U.S. Department of Education and funds the SAS program at Rocky Mountain College. SAS provides holistic, student-centered services, resources and educational opportunities that support and improve graduation for eligible students.

Legal First Name: 

Legal Last Name:

Gender: 

Home Street Address: 

Home City:

Home Zip: 

Email: 

Cell Phone: 

Ethnic Identity (Check all that apply)

Citizenship (Select one)

If you indicated Visa, what type?

Intended start date:

Classification:

Enrollment: 

If a transfer student, from what type of institution?

Have you been awarded federal financial assistance (grants and/or loans)?

Did either parent graduate with a Bachelor's degree from a 4-year college/university?

Do you have a documented disability (physical, chronic medical condition, psychological, or diagnosed learning disability)?

Release and Certification (first and last legal name):

By clicking submit, I hereby grant permission to the Services for Academic Success program to secure information pertinent to my participation in the program at Rocky Mountain College. This release covers access to financial aid information, standardized test scores, transcripts, grade reports, and any information concerning my academic progress and performance. I also certify that the above information is true and complete to the best of my knowledge.

Student Signature: 

Date Signed: