SEED Program Application | Triton College

PERSONAL INFORMATION

First Name *

Middle Name

Last Name *

Preferred Name *

Date of Birth *

Home Address *

Apartment/Unit

City *

State *

Zip Code *

Phone *

Email *

Gender * Male Female Nonbinary Other (You may list in Comments Box at the bottom of this form) I Chose not to Respond

Preferred Pronouns * She/Her/Hers He/Him/His They/Them/Theirs Ze/Zie/Hir I Chose not to Respond

Primary Language

Ethnicity * Hispanic/Latino Not Hispanic/Latino I Chose not to Respond

Race * (Select ALL which apply) American Indian/Alaskan Native African American/Black Asian Native Hawaiian/Pacific Islander White I Chose not to Respond

Veteran Status * Veteran Not a Veteran National Guard/Reservist

Are you a current Triton College Student? * Yes No

INDIVIDUAL NEEDS ASSESSMENT

Transportation * (Select ALL which Apply) I drive my own car I drive someone else’s car Someone else drives me I use public transportation (CTA/RTA/ADA Paratransit/Dial-A-Ride) Uber/Lyft Other (You may list in Comments Box at the bottom of this form) I Chose not to Respond

TELL US ABOUT YOU

Please describe why you want to participate in the S.E.E.D. program

COMMITMENT TO PARTICIPATE

Completing this application does not guarantee admission to the S.E.ED. program. S.E.E.D. program staff will contact individuals who submit a completed application about program eligibility and next steps.

If accepted into the S.E.E.D. program, I agree to the following:

I will attend the in-person S.E.E.D Program Orientation
I will meet with the S.E.E.D. Coordinator weekly for coaching sessions, either in person or virtually
I will attend one mandatory one-to-one coaching session per module with the S.E.E.D. Coordinator either in person or virtually
I will attend all classes and coaching sessions and complete coursework in a timely manner
I will contact the S.E.E.D. Coordinator as soon as I know I will be unable to attend a scheduled coaching session meeting
I will read emails and access the Blackboard page at least weekly.
I will communicate regularly with S.E.E.D. staff regarding schedule changes and concerns that may affect my involvement in the program
I understand that I will not graduate with my S.E.E.D. certificate if I do not complete all program requirements

Participation Disclaimer * I agree to the terms of the Commitment to Participate

RELEASE OF INFORMATION AGREEMENT

I certify that the information I have provided on this application is to the best of my knowledge.

If accepted to the S.E.E.D. program, I give my consent for Triton College S.E.E.D. program to use my photo, video, and other images and provide information on my participation in the S.E.E.D. program on the S.E.E.D. program website, social media account(s), brochures and newsletters. This agreement remains in effect during my years at Triton College.
Furthermore, I understand that by applying for the S.E.E.D. program, I authorize the program staff to obtain records or data pertinent to my participation from other sources; such as but not limited to federal financial aid, monitoring educational progress, evaluating effectiveness of program activities, and fulfilling program reporting requirements
The S.E.E.D. program staff has my permission to communicate verbally and otherwise with staff, faculty, and/or off-campus professionals on my behalf. This includes internship supervisors

Release of Information Disclaimer * I agree to the terms of Release of Information

ADDITIONAL INFORMATION

Comments