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Thank you for your interest in our Student Support Services program! 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 email us at trio@lavc.edu
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Describe your primary reason for applying:
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Attached copy of college ID.
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Is English your first language?
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Are you currently employed?
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Are you a U.S. citizen?
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If no, are you a permanent resident?
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Mother's Educational Level
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Father's Educational Level
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Have you applied for financial aid?
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(Note: Documentation will be obtained from Financial Aid office)
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Are you receiving services from the LAVC Services for Students with Disabilities program (SSD)?
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Attached copy of documentation of your LAVC SSD Verification ex. Letter/Ed. Plan. (If applicable)
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If you did not file an income tax return for the most recent tax year, please indicate your source(s) of income by
placing a check in the appropriate box(es) below:
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Educational Needs & Interests – Mark all that apply
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Is this the first college you have attended:
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Date you enrolled at Los Angeles Valley College:
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Current College Status:
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Have you been out of school 5 yrs. or more?
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Attached copy of High School or College transcripts.
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Are you in any of the following campus programs? Check off all programs that apply:
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Terms of Submission:
By submitting this application, you acknowledge that all of the above information is correct and accurate to the best of your understanding.
I certify that my responses on this form are accurate and complete to the best of my knowledge and that any misrepresentation may be cause for denial or cancellation of admission. I understand that I may be requested to provide income documentation if admitted into TRiO/SSS. I understand that this ELECTRONIC SIGNATURE is a legal representation of my signature. *
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Please select a signature verification type.
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