TRiO SSS 2025 Income Statement

TRiO SSS 2025 Income Statement

Please submit this form to complete your application for the TRIO Student Support Services program at Otero College.
Student Legal Name*

First NameLast Name
Student Identification (S#) Number:*
For student applicants who are considered Dependent, please have your parent or legal guardian complete the rest of this form and sign below. Dependent applicants meet the following qualifications: younger than 24 years old, unmarried or not legally emancipated, parental income is reported on the Free Application for Federal Student Aid/FAFSA.

For student applicants who are considered Independent, please complete the information for your household and sign below. You do not need a parent’s signature. Independent applicants meet the following qualifications: age 24 or older, married or legally emancipated, parental income is not reported on the Free Application for Federal Student Aid/FAFSA.

If you are unsure whether you are an independent or dependent student, please contact TRIO SSS at (719) 384-6835.
Student Status:*

Dependent (Under 24, unmarried, no children, not legally emancipated/ward of court)Independent (age 24 or older, married, legally emancipated or ward of the court, children filed on taxes)
State of Residence*
Household Size:*
Please indicate the number of members in your household
2024 Household TAXABLE Income-check one of the following (Found on line 15 of 1040 form):*

Less than $23,474Between $23,475 and $31,724Between $31,725 and $39,974Between $39,975 and $48,224Between $48,225 and $56,474Between $56,475 and $64,724Between $64,725 and $72,974Between $72,975 and $81,224More than $81,225
By signing this TRiO Application electronically, you confirm that the information provided is true and complete. Your signature is legally binding under the ESIGN Act and, where applicable, UETA. Electronic signatures are valid and enforceable like handwritten ones.

You may request a paper income statement to sign manually, and can ask for a copy of the completed form at any time by calling 719-384-6835. Providing false information may result in removal from the program.
Dependent students are required to obtain a parent/ legal guardian's signature to determine income status. Please copy the URL link and send it to your parent or legal guardian to complete this form.
Student Signature (Use your mouse or finger to draw your signature below)*

Clear
PARENT/ LEGAL GUARDIAN SIGNATURE REQUIRED (Dependent Status Requires parent/legal guardian signature) (Use your mouse or finger to draw your signature below)*

Clear
Date*

MonthDayYear
Date
Should be Empty: