Opportunity Program Interest Form

Jefferson has several programs that open up opportunities for students entering a certain career field, new or returning to college, or facing other barriers to success. This application is for all three opportunity programs, and our staff will review it to determine which program is the best fit for you.

ASAP (Advancing Success in Associate Pathways)
TRIO (Student Support Service)
CSTEP (Collegiate Science Technology Entry Program)

Contact Information

First Name

Preferred Name

Last Name

Email Address

Parent/Guardian Email (Optional)

Cell Phone Number

Birthdate

JCC Student ID (if you are unsure of your JCC ID, please call 315.786.2437. This is also listed on your JCC Acceptance Letter)

Mailing Address

Country

Street

City

Region

Postal Code

Questions related to program eligibility

What is your Program of Study (what degree are you seeking)?

Specify your concentration (if applicable):

Please identify your occupational goal

A student is considered a first-generation college student if their parents did not graduate from college with a 4-year degree (Bachelor's Degree). Are you a first generation college student?

Do you have children?

Are you a student who has a documented disability?

If yes, does the college have a record of it?

Military Affiliation

Are you a U.S. Citizen or Permanent Resident?

Are you a New York State Resident? (Must have lived in New York State for longer than 6 months)?

Pronouns

Gender Identity

Ethnicity: Please select all that apply:

Are you Hispanic or Latino?

Is there anything you want us to know about you?

Please type legal name below.
I agree that by submitting this application the information provided above is true and accurate. I grant permission to Jefferson Community College Access and Opportunity (AOP) staff to communicate with my professors and access my financial information to determine program eligibility. I also allow the use of my photograph, video, and/or recording of my voice for any publicity related to AOP.

Jefferson Community College Website

Opportunity Program Interest Form