TRiO Student Support Services Application

TRiO Student Support Services

Participant Application
PART 1: PERSONAL DATA
Student Identification (S#) Number:*
SS#*
Applicant's Legal Name*

First NameLast Name
Applicant's Preferred Name (optional)

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Campus Address

Dorm Building

Dorm Number

CityState

Zip Code
Home Phone Number

Area CodePhone Number
Work Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Email*
example@example.com
YesNo
MaleFemale
Birth Date:*

MonthDayYear
Date
PART 2: ETHNICITY/RACE/CITIZENSHIP GROUP
YesNo
YesNo
YesNo
Alien Registration Number:
Caucasian/WhiteAfrican American/WhiteAmerican Indian/Alaskan NativeNative Hawaiian/Pacific IslanderAsian
PART 3: MARITAL STATUS
SingleMarriedDivorcedSeparatedWidowed
PART 4: EDUCATIONAL INFORMATION
High School DiplomaGED
Name of School
Year
YesNo
If so, where?
Date you started at Otero:
Full-timeThree-quarter timeHalf-timeLess than half-time
Target completion date at Otero College?*
YesNo
If you plan to transfer to a 4-year college, when?
Name of college:
Associate of Arts (AA - transfer degree)Associate of Science (AS - transfer degree)Associate of General Studies (AGS - non-transfer degree)Certificate
What is your major?*
PART 5: FIRST GENERATION VERIFCATION
YesNo
YesNo
MotherFatherBothNeither
PART 6: DISABILITIES VERIFICATION
YesNo
YesNo
PART 7: INCOME VERIFICATION

Verification requirements for TRiO SSS vary dependent on whether students are Independent or Dependent. A list of federal criteria for independent student status is available at www.fafsa.ed.gov. Please click the link below to complete the TRiO SSS 2020 Income Eligibility Form.

TRiO SSS 2020 Income Eligibility Form
PART 8: WORKSHOPS AND SERVICES
Study Habit TipsTest Taking SkillsHelp Managing MoneyScholarship TipsResume Writing TipsTime Management TipsVocabulary/Math SkillsTips for Relieving StressHelp Setting GoalsNote Taking TipsHelp Navigating the ComputerEnhance Memory
Academic AdvisingCultural EventsTransfer AdvisementCampus ToursFinancial Aid AdvisementPersonal CounselingTutoringCareer Counseling
PART 9: RELEASE OF INFORMATION

I authorize the TRiO Student Support Services Program staff to:

· gather information concerning all my academic progress (standardized test scores, grade point average, earned credit, transcripts, tutoring, etc.) and financial aid reports including Federal tax, FAFSA and verification of income prior to my participation in the program

· obtain information from the ADA office if I fall under the disability status

· gather information for follow-up whenever appropriate, including, but not limited to, transfer and progress to 4-year institutions

· report my eligibility, GPA, and financial aid status to the U.S. Department of Education in accordance with the grant funding regulations

· use my name, photo, or information about me in all college media sources and on the TRiO Facebook page

The information provided on this form is, to the best of my knowledge, accurate and true.
Student Signature (Use your mouse or finger to draw your signature below):*

Clear
Date*

MonthDayYear
Date
Should be Empty: