Summer Bridge Program (START) Application

TRiO Application

Student Support Services/TRiO at PRCC
Summer Bridge Program (START) Application 2024
Students Transitioning to Academic Success & Responsibilities at The Community College (START)
June 26, 2024 – July 25, 2024

All Summer Bridge (START) applicants must be enrolled PRCC students and be approved as eligible for Student Support Services/TRiO. Please be aware that the START Program is limited to the first 30 eligible students enrolled.

SECTION A

PERSONAL INFORMATION

Please Select Your T-Shirt Size (Adult Sizes):

Other:

1. Applicant Information

Last Name:

First Name:

Middle Name:

Address:

Street:

City:

State:

Zip Code:

Gender:

Social Security Number (no dashes):

PRCC Student ID #:

Date of Birth

Age:

Mobile #:

Home Phone Number:

Student Email:

2. Parent/Guardian/Spouse Information (who we will contact)

Last Name:

First Name:

Middle Name:

Parent/Guardian/Spouse Address:

Street:

City:

State:

Zip Code:

Parent/Guardian/Spouse Email:

Parent/Guardian/Spouse Cell Phone:

Parent/Guardian/Spouse Home/Work Phone:

Emergency Contact Person:

Emergency Contact Phone Number:

3. Ethnicity (required for reporting purposes; does not determine acceptance):

Ethnicity

African American/Black

Caucasian

Hispanic

Native-American

Asian

Other

Other:

4. Citizenship:

Citizenship:

US Citizenship

Legal Permanent Resident

Permanent Resident Number:

If applicable, please submit a copy of your Permanent Resident Card with your completed application, including but not limited to, Driver’s License State Identification Card, Certificate of US Citizenship, Immigration Documentation with photograh.

Choose File

SECTION B

ELIGIBILITY INFORMATION

1. Income Data

a) Are you considered:

Dependent: (23 years old or younger, not married, no dependents, not a veteran of the U.S. Armed Forces, not an orphan or ward of the court)

Independent: (24 years old or older, married, have dependents, a veteran of the U.S. Armed Forces or an orphan or ward of the court)

b) FAFSA

Have you completed the 2023-2024 FAFSA (for the Summer term)?

Yes

Have you completed the 2024-2025 (Fall/Spring) FAFSA?

Yes

c) Do your parents claim you as a dependent on their tax return?

Yes

d) Do you have children for whom you provide care for 50% or more of the time?

Yes

2. Family Educational Background

a) Did Parent 1 graduate from college with a 4-year degree (bachelor’s)?

a) Did Parent 2 graduate from college with a 4-year degree (bachelor’s)?

3. Disability Verification

a) Do you have a documented/verifiable disability (physical, learning,emotional)?

Yes

If yes, have you completed the online disability application to register with Disability Services?

Yes

b) Are you registered through Vocational Rehabilitation?

Yes

c) Other Additional Information:

4. Reference Person

Please provide information for one contact, not a close relative, we can speak to
regarding your potential for academic and personal growth:

Name:

Phone/Mobile

Relationship:

Email:

SECTION C

ACADEMIC INFORMATION

1) Which PRCC Campus will you attend this fall:

2) The following information is confidential and held necessary for us to screen for your eligibility to the START (Summer Bridge Program) and assist you in accessing other services available.

ACT Scores

ACT Not Taken Yet

Date Taken:

English:

Math:

Reading:

Science:

Composite Score:

When do you plan to take the ACT?

3) Check all that apply:

Have a financial need/low income

First in family to go to college

Complete a GED

A documented disability

Low high school GPA

Working and going to school

Re-entry to college/school

Out of school 5 years or more

4) Expected PRCC Enrollment Term:

Summer, 2024

Fall, 2024

Spring, 2025

Undecided

5) College Major: (If undecided, write “undeclared”)

6) Career Goal (if known):

7) Have you participated in other TRiO Programs? If so, please indicate which program(s):

Yes

TRiO Programs:

Educational Opportunity Center (EOC)

Talent Search

Student Support Services

Upward Bound

8) Do you plan to transfer to:

USM

William Carey

Other

Specify:

9) What is the highest degree you are seeking:

Certificate

AA/AS (2 year degree)

BA/BS (4 year degree)

Undecided

Other (Specify)

Other (Specify):

High School Attended:

Graduation Date:

Please check all that apply:

High School Diploma Student – GPA

GED Student

Occupational Diploma

HS Diploma Student GPA:

GED Date:

Community College Student – Transferable GPA:

Please check one:

SECTION D

OTHER INFORMATION

1) Will participating in START conflict with your job or other responsibilities: The START Program meets face-to-face Monday to Thursday during the second summer term with one Friday field trip date (tentatively set for July 19th)

Yes

If yes, explain:

2) Do you have access to reliable internet access and a computer?:

Yes

3) What are your housing plans while attending PRCC?:

Stay in the Dorm

Commute

Have you completed a PRCC Dorm Application for the: (Check all that apply)

Yes, Summer 2024

Yes, Fall 2024

No, I have not completed a dorm application

How did you find out about the START Program?: (Check One)

Other (Specify):

SECTION E

PERSONAL ESSAY QUESTIONS

Type your answers on a separate sheet of paper, with your name, and email to us, at cbonnette@prcc.edu, or upload them below.
1. Besides financial challenges, what academic or personal challenges do you think you will face in college & why?
2. Why do you think you should be chosen for the Student Support Services/TRiO START Program?
3. How do you see the Student Support Services/TRiO START Program assisting you in reaching your goals?
4. What steps (if any) have you taken to prepare for college?

Personal Essay:

Choose File

SECTION F

INFORMED CONSENT

I authorize Student Support Services/TRiO (SSS) to gather information concerning my academic progress and financial aid status. To verify income information, FAFSA documents on file with Financial Aid will be reviewed for the program’s income requirements. I understand that this information will be used in determining my eligibility for SSS activities and programs and will be kept strictly confidential. I grant permission to SSS to gather information for follow-up whenever appropriate. I am aware that SSS reports to the Department of Education in accordance with their grant funding regulations. I certify that the information provided in this application is true and complete to the best of my knowledge. I agree to provide documentation upon request to verify the information reported. I am aware that personal information provided to SSS is protected under the Family Education Rights and Privacy Act of 1974 (FERPA).

*NOTE: If you are a member of a two-parent household, both parents must sign this application or it will be considered incomplete.

Student Signature: My name below will serve as my signature in approving my Informed Consent.

Today’s Date

Parent/Guardian Signature (If applicant is under 18): My name below will serve as my signature in approving my Informed Consent.

Today’s Date

Parent/Guardian Signature (If applicant is under 18): My name below will serve as my signature in approving my Informed Consent.

Today’s Date

SECTION G

APPLICATION DEADLINE/MAILING ADDRESS:

Deadline Information:
Application packets must be received before May 31, 2024, and must be complete to receive the fullest consideration. All applicants will be notified of their status in the Student Support Services/TRiO Summer Bridge Program (START), as soon as possible thereafter.

Email any required documents to cbonnette@prcc.edu by the application deadline.

Questions? Please call or email:

Mrs. Carlette Bonnette, Bridge Program Coordinator
Student Support Services/TRiO
PH: 601-403-1356 or 985-261-1030
Email: cbonnette@prcc.edu

Sarah Smith, Academic Success Advisor
Student Support Services/TRiO
PH: 601-403-1043
Email: scsmith@prcc.edu

Jennifer Cottrell
Student Support Services/TRIO
Project Director
Phone: 601-403-1469
Email: jcottrell@prcc.edu

SECTION A

1. Applicant Information

2. Parent/Guardian/Spouse Information (who we will contact)

3. Ethnicity (required for reporting purposes; does not determine acceptance):

4. Citizenship:

SECTION B

1. Income Data

2. Family Educational Background

3. Disability Verification

4. Reference Person

SECTION C

SECTION D

SECTION E

SECTION F

SECTION G

POPLARVILLE CAMPUS
101 HIGHWAY 11 NORTH
POPLARVILLE, MS 39470

FORREST COUNTY CAMPUS
5448 HIGHWAY 49 SOUTH
HATTIESBURG, MS 39401

HANCOCK CAMPUS
454 HIGHWAY 90, Suite D
WAVELAND, MS 39576

Each community college president is asked to bring two (2) wrapped door prizes, minimum value of $50 each. We will have a station set up at the conference for you to drop off the door prizes.

Each community college is asked to provide name tags for their Board members, administration, and staff attending the conference.

Get
Info

Schedule
A Tour

Apply
Now

Summer Bridge Program (START) Application

SECTION A

1. Applicant Information

2. Parent/Guardian/Spouse Information (who we will contact)

3. Ethnicity (required for reporting purposes; does not determine acceptance):

4. Citizenship:

SECTION B

1. Income Data

2. Family Educational Background

3. Disability Verification

4. Reference Person

SECTION C

SECTION D

SECTION E

SECTION F

SECTION G

POPLARVILLE CAMPUS101 HIGHWAY 11 NORTHPOPLARVILLE, MS 39470

FORREST COUNTY CAMPUS5448 HIGHWAY 49 SOUTHHATTIESBURG, MS 39401

HANCOCK CAMPUS454 HIGHWAY 90, Suite DWAVELAND, MS 39576

Each community college president is asked to bring two (2) wrapped door prizes, minimum value of $50 each. We will have a station set up at the conference for you to drop off the door prizes.

Each community college is asked to provide name tags for their Board members, administration, and staff attending the conference.

GetInfo

ScheduleA Tour

ApplyNow

POPLARVILLE CAMPUS
101 HIGHWAY 11 NORTH
POPLARVILLE, MS 39470

FORREST COUNTY CAMPUS
5448 HIGHWAY 49 SOUTH
HATTIESBURG, MS 39401

HANCOCK CAMPUS
454 HIGHWAY 90, Suite D
WAVELAND, MS 39576

Get
Info

Schedule
A Tour

Apply
Now