TRIO Eligibility Verification Form 2020-21
The following information is requested to verify income eligibility for the TRIO Achievement Program. Responses to all items on this form are required and necessary for federal TRIO documentation. Completing the form does not guarantee selection/participation in the TRIO Achievement Program at Knox College. Questions regarding this form may be sent to Risa Lopez, Executive Director of TRIO and McNair Programs, at rlopez@knox.edu.
Student Name
*
First Name
Middle Initial
Last Name
Are you a citizen, national, or permanent resident of the U.S.?
*
YES
NO
Have you, the student, previously earned a baccalaureate/Bachelor's degree?
*
YES
NO
Have either of your custodial parents earned a baccalaureate/Bachelor's degree?
*
YES
NO
Are you a student with a learning/physical/psychological disability that impacts your educational experience? (Documentation from a provider/counselor will be required if applying under this criteria.)
*
YES, and I am able to provide documentation.
YES, but I am unable/prefer not to provide documentation at this time.
NO
If YES, who will provide a confirmation letter of your disability status?
Knox College Disability Services
Illinois Department of Rehabilitation Services
High school counselor/administrator
Other licensed physician/psychologist
Financial Information
Please provide the following amounts based on your parent/s' completed 1040 federal tax information for 2019 if you report parent information on the FAFSA. If Knox College considers you a self-supporting student according to federal criteria (i.e. not required to provide parent information on the FAFSA), please provide your individual tax information for 2019. If you parents are non-tax filers, please initial in the non-filer declaration box below.
State of Family Residence:
*
Illinois, California, Iowa, Texas, etc.
2019 Adjusted Gross Income:
*
Line 8b on federal Form 1040
2019 Taxable Income:
*
Line 11b on federal Form 1040
Household Size:
*
Include in the number the student (even if living away at college), parent/s, and siblings who are under the age of 24 if the parents provide more than half of their support. Also include other people if they now live with the parents and the parents provide more than half of their support. If the parents are divorced, include only the parent with whom the student lives (custodial parent) and step-parent if applicable.
If your parent/s will NOT file taxes for the 2019 tax year, please initial here.
Non-filer declaration
Signature/s
Your signature on this form is your assurance that, to the best of your knowledge, all information provided is true and accurate. Parent signature is required unless Knox College considers you a self-supporting student according to federal criteria.
Student Signature
*
Parent Signature
*
enter X if Knox College considers you a self-supporting student according to federal criteria.
Submit
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