Spartanburg Community College

	Success Network Student Application

Please complete all items on this application, sign the applicant consent, and submit the completed application to Success Network. For assistance, contact Success Network at (864) 592-4780. Completed applications may be submitted online at www.sccsc.edu/success, in person in the Success Network Office (Suite 174 of the Dan L. Terhune Student Services Building), by fax (864-592-4915), or by mail to:
Spartanburg Community College Success Network P.O. Box 4386 Spartanburg, SC 29305

Contact Information


Last Name	First Name	Middle Initial	College ID#


Address	City	State	Zip Code


Home Phone	Cell Phone	Work Phone	Other Phone


Email Address	Best way to contact you

Success Network Eligibility Criteria

1. Are you currently enrolled as a student at Spartanburg Community College (SCC)?

Yes No

If no, are you enrolled in courses for a future academic term?

Yes No

If yes, indicate term:

2. Please indicate the status of your high school education (select only one):

Received high school diploma

Received certificate of completion or attendance

Received GED

Currently enrolled in high school If yes, select grade enrolled:

Other (explain):


3. Have you previously attended a college other than SCC? Yes No

If yes, indicate college(s): Dates of attendance:

Indicate award earned: No award Certificate Diploma Associate’s degree Bachelor's degree


4. Are you a U.S. citizen? Yes No
	If no, are you a legal resident eligible for federal student financial aid? Yes No Unsure

5. Has either of your parents graduated from a four-year college or university?


6. Are you a student with a disability?	Yes No Unsure

If yes, have you provided documentation of your disability to SCC’s Disability Services Office?

Yes No

7. What is your current program of study at SCC?

Are you considering any other program of study?

Yes No Unsure

If yes, what other programs of study are you considering?


8. What is your academic goal while attending SCC?

If none of these, explain :

9. Have you ever or are you currently receiving services from another TRIO program such as:

Upward Bound, Talent Search, Educational Opportunity Centers, or Student Support Services?

Yes No Unsure

If yes, which program and when?

Academic Information

10. Do you speak English as a second language?

Yes No

11. If you are currently employed, how many hours do you typically work per week?

12. How many hours do you typically study per week?

13. What are your academic weaknesses? (Check all that apply.)

Math English Writing Reading Science Computer skills Study skills Test anxiety

Note-taking Time management Interest/motivation Other (specify) :

14. Are you currently having difficulty in your courses, or do you anticipate having difficulty in future courses?

Yes No

If yes, which courses?

15. To get help with your academic and/or career needs, how often do you access:


	The Learning Center (TLC)
	Library
	AIM Center
	Instructor (outside of class)
	Advisor
	Career Planning and Placement

16. What year did you last attend high school?

17. Was high school academically difficult for you?

Yes No

If yes, explain:

18. How do you think Success Network can help you? (Check all that apply.)
	Tutoring in specific course Improving my study skills Help with transferring to a four-year college Help with career goals
	Adjusting to college life Providing encouragement and motivation Other (specify):

19. How did you learn of Success Network? (Check all that apply.)

	SCC instructor/advisor/staff (name): Classmate SCC Website
	SCC catalog or handbook E-mail/letter Other (specify):

Applicant Consent to Release Information

In order to determine your eligibility for Success Network services, it is necessary to obtain information related to your academic progress, your financial aid records and your utilization of campus resources at Spartanburg Community College. We ask that you sign the following permission statement.

I hereby certify that I am the applicant identified on this application and that all statements made on this application are true and complete to the best of my knowledge. I consent to the release of my academic and financial aid records to Success Network. I also give permission for Success Network to confer with my instructors and with the staff of other on-campus resources regarding my program eligibility and my academic progress and needs.

Name:

Date:

College ID#:

Spartanburg Community College does not discriminate on the basis of race, color, religion, age, sex, national origin/ethnic origin,
or disability in its admission policies, programs, activities, or employment practices.

To submit this application electronically, click on the submit button below.

To submit your application in person, by fax, or by mail, print the .pdf version of this application form.
Success Network is located in Suite 174 of the Dan L. Terhune Student Services Building.

Spartanburg Community College
Success Network
P.O. Box 4386
Spartanburg, SC 29305
Phone: (864) 592-4780
Fax: (864) 592-4915
Email: successnetwork@sccsc.edu

Success Network is a Student Support Services program funded 100% through a federal TRIO grant in the amount of $276,570 by the U.S. Department of Education.