Trio-SSS Application

Select a date from the calendar.


What is the highest level of education achieved by your parent or guardian? If your parents are/were divorced and you resided with them until you were 18, reply only in regards to the parent who had primary custody:

Dependency Status:(If you answered “no” to all four questions, you may be considered dependent status. If you answered “yes” to at least 1 question, you are likely considered independent status.)

Check the range that includes your household taxable income for last year (2017). Taxable income is reported on the following lines of your tax form: 1040 (Line 43)
1040A (Line 27)

The above information is true and complete, to my knowledge. I understand it is confidential and will be used for intake purposes. Further, I release the following information to TRIO-Student Support Services to verify eligibility, determine appropriate services, and to track academic progress: mid-term and final grades, transcripts/registration information, financial aid information, standardized test scores (ACT/SAT/COMPASS/ACCUPLACER, etc.), income information, transfer information, and contact instructors/advisors. Providing my cell phone number enrolls me in the texting program that I can opt out of at any time, TRIO nor SRC are responsible for any texting charges. I understand completion of application does not guarantee acceptance to the SRC TRIO-SSS program. I understand the TRIO Director reserves the right to admit or deny any student’s acceptance to the SRC TRIO-SSS program. Students are accepted into the program on a first come, first serve basis and is based on eligibility criteria outlined by the Department of Education that funds the program.
Electronic Signature:

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