Excel Program Application

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Date of Birth

Are you a High School Graduate?

If no, do you have a GED?

Are you a U.S. Citizen?

If not, enter your alien registration number:

Did either of your parents graduate from VHCC?

Did either of your parents graduate from a 4 year college or university?

VHCC Email Address

Phone Number

Marital Status

Have you earned college credit?

If so, through which of the following?

Identify your curriculum at VHCC:

ETHNIC ORIGIN - Demographic Information

Self Assessment

The Excel program uses the needs assessment to best serve students. The information is kept strictly confidential. Honest answers help effectively meet your needs, but feel free to withhold personal information you are not comfortable disclosing. There are no right or wrong answers.

Please identify your current skill level in the following areas using the the following scale: 1 = Skill is challenging 2 = Comfortable with this skill 3 = One of my best skills.

Planning and Goal Setting

Balancing School/Work Life

Managing Stress

Math Skills

Writing Skills

Reading Skills

Study Skills

Note-Taking Techniques

Test-Taking Strategy

Time Management

Officials of The Excel program have my permission to obtain from the VHCC Admissions/Records, Financial Aid, and Veterans Affair Offices a copy of my grades, transcripts, test scores, and financial aid information as needed. They may also have my permission to contact counselors and teachers with whom I have worked or am working with at VHCC and other agencies and institutions. I understand that, as a new program participant, I will be assigned to an academic mentor/coach at the beginning of the term of my initial enrollment and will participate in intensive coaching for the first two semesters at VHCC.

By submitting this form you certify that the above information is accurate and complete to the best of my knowledge.

TRIO Services

Please identify the most helpful services.

Student Background

Will you be working while attending college?

How many hours?

Do you feel comfortable with technology (email, computers, etc.)?

What is your greatest academic concern?

What is your greatest barrier to success personally or academically?

Are there any other circumstances that affect your education?