STC Application (TCC)

Referral Information

How did you hear about Stay the Course?

Referring TCC Faculty/Department

Other Referral Source

Student Demographic Information

First Name

Last Name

Date of Birth

Please enter a valid Date of Birth in the format (MM/DD/YYYY)

Email address

Please enter the email address provided to you by your school

Telephone

Street Address

City

State

Postal/Zip code

County

Country

What is your preferred method of contact?

CallTextEmailCheck all that apply

School Information

School Name

What is your home campus?

TCC Specific Questions

1. Are you at least 18 years old?

2. Are you dual-enrolled in high school and community college?

3. Are you on any level of academic suspension?

4. (a) Have you passed at least one Texas Success Initiative (TSI) Assessment or the developmental equivalent course? -OR- (b) Are you enrolled in a developmental course to the TSI, or co-requisite classes?

Find this information on your Degree Audit thru WebAdvisor.

5. What is your highest level of education?

Gender

Another race or ethnicity (specify here)

Annual Family Income

$

Employment Status

Type of Employment

Parent(s) Highest Level of Education

Which category best describes your household?

Are you a dependent of your parent(s) or guardian(s)?

Student ID

TCC Specific - Document Upload

Please upload the following documents. If you do not choose a file, please click on the link that reads "Remove".

TCC My Progress document

Unofficial TCC transcript

Consent Information

By submitting this application, I authorize Stay the Course program staff to contact me by post, phone, e-mail, and/or text message (SMS) about the Stay the Course program.

Yes, I authorize.No, I do not authorize.