Triumph and Surge Application

* = required fields

Semester * Fall 2024 Spring 2025 Summer 2025

Student Contact Information

First Name *

M.I.

Last Name *

Address *

Apt#

City *

State *

Zip Code *

Phone Number (Preferred for contact) *

Triton Email Address *

Student Demographic Information

Triton Colleague ID *

Date of Birth *

Racial Identity *

What is your parental status? *

Self-identification is important, and we understand that we each have our own understanding of the words used to describe our own experiences. So that we can best honor your identity and experiences, please describe how you identify in the response box below AND select (as many as you want) from the list below.

In your own words, what is your gender identity?

Please share your pronouns

Select the pronouns you use, even if the same as above. She/Her/Hers He/Him/His They/Them/Theirs Ze/Hir/Hirs No Pronoun No Preference Not Listed Decline To Answer

Student Education Information

High School Attended *

Colleges/Universities Attended *

First Generation Status Information

Does your Mother have a Bachelor's (4-year college) degree? *

Does your Father have a Bachelor's (4-year college) degree? *

Did you Apply for FAFSA/R.I.S.E. act? *

If not, could you please explain why you did not complete the FAFSA/RISE ACT

Would you like to learn more about FAFSA or RISE Act? *

The FAFSA helps determine eligibility for federal financial aid, while the RISE Act allows undocumented and DACA students in Illinois to apply for state aid, like the Illinois MAP Grant. So, FAFSA is for federal aid, and the RISE Act is for state aid in Illinois.

Student Military Information

Serving active duty in the armed forces? *

Additional Information

What is your housing situation today? Check all that apply. * I have a steady place to live I have a place to live today, but I am worried about losing it I do not have a steady place to live Decline To Answer

What are your concerns about your housing situation? Check all that apply. * Condition of housing Lack of permanent housing Ability to pay rent and/or utilities Safe environment Other Decline To Answer

Are you facing any food insecurities? *

Would you like to receive information regarding nutrition resources. (i.e., food banks/pantries, snap benefits) *

Do you have reliable transportation to and from Triton College? If not, explain below. *

If you answered no to reliable transportation, please explain.

Student Response

Please provide short responses to the following questions:

Why do you want to participate in this mentoring program? *

What do you hope to gain from joining TRIUMPH and SURGE? *

Please explain any scheduling issues that may prevent you from attending weekly workshops and meetings with your advisor/mentor. *

What are your hobbies/interests? *

Participation Agreement

The TRIUMPH&SURGE Program can help you achieve your goals by providing:

A professional mentor to assist with Academic career goals.
Group and individual academic tutoring sessions provided by ASC.
Presentations on specific skills necessary to be successful in college
Advice and assistance in course selection
Financial Literacy/ Planning
Company visits and Campus visits to four – year institutions and on campus meetings with university representatives
Individualized Personal, Career, and Academic Advisement
Academic Programs, Cultural events, and Mental health support

You can ensure your own success by:

Participating in workshops, academic programs, conferences, meetings, and events with advisor.
Participating in the mentoring program
Participating in check – ins, study tables, and individual or group meetings.
Consulting with your Student Success Advisor before adjusting class schedule.
Attending class regularly, staying in communication with instructor, and completing all assignments.
Immediately sharing with your SSA or Mentor any concerns that may affect your focus on school.
Reading ALLTRIUMPH&SURGE – mails at least once a day.
Arranging and keeping appointments with your SSA and Mentor
Completing TRIUMPH&SURGE Exit Interview when leaving Triton College. In completion, will cause a HOLD to be added to account.

Student Consent… I Understand:

TRIUMPH&SURGE may share and/or obtain information from appropriate college personnel and outside educational institutions to assist me in reaching my educational or workforce goals.
ALL TRIUMPH&SURGE participants must maintain a 2.5 Cumulative GPA to attend any off-campus activities.
ALL TRIPUMPH&SURGE participants must attend a minimum of 2 study tables sessions or ASC appointments a week.
That as a required component of the program, I must participate in the following:
- Participation in workshops
- Attendance at a minimum of three program events each semester
- ALL participants are required to submit a completed FAFSA/RISE ACT application and at least one scholarship application annually no later than the priority deadline date
- Participate in a minimum of 1 transfer center and career services workshop
- I must check my Triton email and program GroupMe at least once a day.
- Photographs, videos or other images of me maybe used to promote the Triton College TRIUMPH&SURGE Program.
- By follow the expectations outlined above, I can ensure that I will remain in good standing with TRIUMPH&SURGE at Triton College.

Participation Information

Major Field of Study *

What are your plans after Triton College? *

Academic Goals *

Career Goals *

Which Colleges/Universities are you Interested in transferring to? *

Are you Interested in any resources? Such as: Housing, Transportation, Food, Medical Assistance

Student Verification

By signing this application, I attest that all the information on this application is true and accurate. I authorize the release and disclosure of official school records to TRIUMPH and SURGE; understanding that the information in these records will be used only to assess need for program services, including referral for financial assistance, but not limited to scholarships, federal financial aid, work study, monitoring educational progress, evaluate the effectiveness of program activities, and fulfill program reporting requirements. I also allow TRIUMPH and SURGE and Triton College to use my image for program promotional purposes.

Verification Confirmation *(represents electronic signature)

Today's Date * (mm/dd/yyyy)

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