TRiO Student Support Services

Faculty/Staff Student Referral Form

Is there a student you think would benefit from the support services offered by TRiO Student Support Services? If yes, please fill out this student referral form and a member of the TRiO staff will contact the student. If you have any questions, please email Heather McKnight, Project Director at heather.mcknight@edcc.edu

1. Student Information (At least one of B-D required)

A: First and Last Name (required)

B: Address

D: Email

D: Phone

2. Reason for referral (required)

3. Knowledge of student's eligibility status: (At least one required)
Low Income
First Generation college student
Disability
Not aware of eligibility

4. Referring Faculty/Staff Information

Name (required)

Department

Your email address if more information is needed

Would you like to be added to a list serve to receive updates and information about the TRiO Student Support Services program? If yes, check this box.

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Edmonds Community College • 20000 68th Ave W Lynnwood, WA 98036 • (425) 640-1459

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Last updated: 02/1/08