TRIO Student Support Services is a full-service academic assistance program funded by the U.S. Department of Education. We are here for your current and future success. And the best part is, it’s all FREE!!!

What is TRIO Student Support Service?

TRIO Student Support Services is a full-service academic assistance program funded by the U.S. Department of Education. We are here for your current and future success.

Want help with your FAFSA? - We can do that!

Not sure how the transfer process works? - We got you!

Need to find a scholarship to help pay for college? - We got a list!

Want new experiences to fulfill your college experience? - Get on the bus!

Need help finding your dream transfer school? - We can do that too!

And the best part is, it’s all FREE!!! Please complete the application below to see if you qualify.

A Federally Funded TRIO Program

STUDENT APPLICATION

The TRIO Student Support Services (SSS) program at Illinois Eastern Community Colleges (IECC) requests the following information for the purpose of considering you for participation in the SSS progam. Participants must be at least a half-time student in need of academic support services, AND be able to meet at least one of the following criteria:

1. Neither parent received a Bachelor’s Degree (4-year degree)

2. Eligible based on income level

3. Documented disability

What year are you attending or plan to attend an IECC school?

Semester

College attending

Last Name:

First Name:

Middle Initial:

Address:

City:

State:

Zip:

E mail Address:

example@example.com

Cell Phone:

Emergency Contact Phone:

Relationship to Emergency Contact:

Birth Date (M D Y):

Date

Student ID #: (Leave blank if you don't know)

Identify:

Ethnicity:

Race (check all that apply):

Are you a U.S. Citizen?

If "No", are you a Permanent Resident?

If "Yes", what is your USCIS#:

What other TRIO programs have you ever participated in?

Have you previously attended other colleges or universities?

If "Yes", where did you attend previously?

Class Standing:

Have you earned a High School Diploma or GED?

What year did you earn your High School Diploma or GED:

Do you plan to attend:

What is your college degree program?

Major?

Do you plan to transfer to a 4-year university?

If "Yes", do you know where you would like to transfer?

What is the highest level of education COMPLETED by your Mother (Birth or Adoptive)?

What is the highest level of education COMPLETED by your Father (Birth or Adoptive)?

Dependency Status – Please answer “YES” or “NO” to the following questions.

Do you have children or other dependents (other than a spouse) who lives with you and receives more than half of their support from you?

Since you turned 13, were you ever an orphan, in foster care, or a ward of the court?

Are you or were you a legally emancipated minor?

Do you or did you have a legal guardian other than a parent or step-parent?

Are you a veteran who was on active duty and released under a condition other than dishonorable?

Are you serving on active duty in the military (other than training)?

Are you married or separated (not divorced)?

Have you been determined to be an independent student by a FCC, LTC, OCC, or WVC Financial Aid Office?

If you answered “NO” to ALL Dependency Status questions you are considered a “Dependent Student” and will need to provide Parent/Guardian information on the Student / Family Income Section.

If you answered “YES” to ANY Dependency Status questions you are considered an “Independent Student” and will need to provide
ONLY YOUR information on the Student / Family Income Section.

After answering the Dependency Status questions:

Student / Family Income – Taking into account if you are a “Dependent Student” or “Independent Student” please provide the following information. If the individual completing this section did not or is not required to file taxes, please put “$0” for Adjusted Gross Income AND Taxable Income.

Did the individual completing this section file an income tax return?

How many people are in your family (including yourself)?

If you filed or plan to file, what is your adjusted gross income? (IRS Form 1040, line 11)

If you filed or plan to file, what is your taxable income? (IRS Form 1040, line 15)

What type of financial assistance are you receiving? (Check all that apply)

If "Other" please specify.

Would you like to report a documented disability that could affect your education? This information is voluntary and you are not required to answer this question. Any information provided will be kept confidential and used for this program only. Any refusal to provide information will not subject you to any adverse treatment. Any information provided will only be used for this program and for no other purpose. Note: Documentation of disability is required. Disability documentation for any IECC student is retained in confidential files.

What services have you received to accommodate this disability?

I certify that the information that I have provided on this SSS application is correct and complete. By signing this form, I authorize TRIO Student Support Services to obtain any and all information and documentation necessary for processing and the ongoing evaluation of my academic pursuits. I also give my permission for the TRIO Student Support Services staff to share my information (including but not limited to IEP, 504, Test Scores, FAFSA) with other staff, faculty, and mentors if it will assist in my

Student Signature:

Date:

Date

Parent/Guardian Signature: (* Required for Dependent Students)

Date:

Date

Illinois Eastern Community Colleges, pursuant to the requirement of Titles IV, VI, and VII of the Civil Rights Act of 1964 and Title IX of the Education Amendment of 1972, does not discriminate against applicants, employees, or students on the basis of race, color, religion, sex, age, handicap, or national origin in its employment policies and/or educational programs or activities, including admission to such. Inquiries concerning this policy should be directed to the affirmative action office of the college: IECC, 233 E. Chestnut St., Olney, Illinois 62450. Phone: (618) 393-2982

Illinois Eastern Community Colleges adhere to the Federal Regulations of the Americans with Disabilities Act of 1990 and offer appropriate services, programs or activities with reasonable accommodations to any qualified disabled individual upon request.

Student's Name:

Today's Date

Date

School:

Please check any of the following items which describe you:

What obstacle(s) would most likely prevent you from completing your academic goals? (Check all that apply):

Difficulty in one or more of the following academicareas:

What other areas will you need assistance with? (Financial)

What other areas will you need assistance with? (Personal Issues)

What other areas will you need assistance with? (Transfer)

What other areas will you need assistance with? (Career)

Academic goals for this year:

Short Term (This semester):

Long Term (This academic year):

How would you describe yourself:

Explain why you selected your major and/or career field (OR If you are undecided) What are your biggest strengths:

Why do you think you should be considered for the SSS program:

PRIORITY WILL BE GIVEN TO STUDENTS WHO INTEND TO TRANSFER AND COMPLETE A BACCALAUREATE DEGREE

Affirmative Action

ADA Compliance Statement

Needs Assessment Survey