• Mid Michigan College
  • TRIO SSS PARTICIPANT APPLICATION

  • PERSONAL DATA

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  • ETHNIC GROUP

  • CITIZENSHIP

  • FIRST GENERATION STATUS

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  • DISABILITY INFORMATION

  • If you are not currently registered and would like information about services, contact Student Accommodation Services at accommodations@midmich.edu or (989) 317-4613.

  • EDUCATIONAL INFORMATION

  • INCOME VERIFICATION

  • According to the federal policy Higher Education Act(1), TRIO SSS must provide documentation of a student’s eligibility for the program to the U.S. Department of Education, which includes first generation and low-income status. We must verify this for all students who apply to TRIO SSS.

    Definitions to help you determine your income status:

    • Dependent: A student that can be claimed by his or her parent(s) as an exemption on tax forms and/or does not meet one of the following criteria as an independent student.
    • Independent: A student is only considered independent according to Federal Financial Aid if they meet one of the following criteria:
      • Is 24 years old or older by December 31 of the award year
      • Is married Has legal dependent(s) other than their spouse
      • Is a veteran of the Armed Forces of the United States
      • Is an orphan or ward of the State of Michigan or ward of his/her residential State
      • Has received a dependency override through Mid Michigan College Financial Aid

    This section must be completed by the student if the student has been deemed independent by Financial Aid. If the student is dependent, the parent(s) must complete and sign this form. See above for definitions to determine your income status.

  • Federal TRIO Programs Current-Year Low-Income Levels
    (Effective January 15, 2020 until further notice)
    Size of Family Unit | Taxable Income
    1 | $19,140
    2 | $25,860
    3 | $32,580
    4 | $39,300
    5 | $46,020
    6 | $52,740
    7 | $59,460
    8 | $66,160


    For family units with more than eight members, add the following amount for each additional family member: $6,720 for the 48 contiguous states, the District of Columbia and outlying jurisdictions; $8,400 for Alaska; and $7,725 for Hawaii.

    The term "low-income individual" means an individual whose family's taxable income for the preceding year did not exceed 150 percent of the poverty level amount.

    The figures shown under family income represent amounts equal to 150 percent of the family income levels established by the Census Bureau for determining poverty status. The 2019 poverty guidelines are in effect as of January 15, 2020. Federal Register notice was published January 17, 2020.

  • Student Profile

  • Please any and all statements that apply to you.

  • Please check any and all of the following where you would like help or support.

  • Participant Agreement and Release of Information

  • I understand that applying to Mid Michigan College TRIO Student Support Services (SSS) does not guarantee acceptance into the program. I may be fully accepted, provisionally accepted, or denied based on the need for services, academic record, academic preparedness and progress, credit hours, financial aid status, and level of engagement.

    Students who have already earned a prior degree or who have defaulted on a loan are not eligible. Students on Financial Aid Warning, Approved Appeal, or on Academic Probation may be provisionally accepted until they are meeting Satisfactory Academic Progress.

    I understand that if I do not meet the expectations and academic goals, I may be ineligible for the Mid TRIO SSS.

    I am committed to my education, academic goals, and completion of my certificate and/or degree. I need to be fully engaged and strive for 100% classroom attendance and participation. I will meet the program expectations within my four years of eligibility:

    • Complete 100% of the courses I enroll in each semester or seek assistance if not, and maintain a semester cumulative GPA of 2.0 or higher
    • Complete ORT 101/102 (on-line Navigation Seminar)
    • Contact with Success Coach two times per semester
    • Contact with Career Coach one time per semester
    • Participate in one give-back (volunteering activity)
    • Participate in at least one of the following: workshop, cultural enrichment activity, job shadow, or college/university visit
    • Complete assessments (CSI, Focus 2, LASSI, and MYSA)
    • Plan to attend the Welcome Breakfast and Leadership Banquet

    I hereby authorize the Mid TRIO SSS program staff to:

    • Gather information about my academic progress (placement test scores, GPA, earned credits, transcripts, tutoring sessions, etc.) and financial aid status prior to acceptance and during the program including, but not limited to, transfer to a four-year institution.
    • Information about academic accommodations, if I meet disability status.
    • Report my eligibility and financial aid status to the U.S. Department of Education.
    • Use photographs of me (individual and group) for informing others about TRIO SSS.
    • Use aggregate data to promote and inform Mid students, faculty, and staff about TRIO SSS.
    • Require that I provide documentation, upon request, to verify the information reported.

    I understand that this form will become part of my TRIO SSS file at Mid Michigan College. I am aware that personal information provided to the Mid TRIO SSS Program will be protected under the Federal Education Rights & Privacy Act (FERPA) of 1974. No one will have access to the information unless they work for Mid Michigan College and/or the TRIO SSS Program and have a legitimate need to know under TRIO SSS and Mid Michigan College guidelines.

  • AFFIDAVIT OF TRUTH STATEMENT

  • To the best of my knowledge, the information provided in this form, and any other supporting documentation, is true. I understand that this authorization is valid for the duration of my enrollment as well as five (5) years after I cease to be enrolled as a student.

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  • Significant effort has been made to ensure this content meets accessibility guidelines. If you encounter a barrier you can report the barrier at midmich.edu/reportaccessibilitybarrier or contact TRIO SSS at (989) 386-6622 x225 or trio@midmich.edu.

    Mid Michigan College strongly endeavors to broaden our diversity, promote equal opportunity, and provide a safe environment within its community. Mid is an equal opportunity employer and educational institution that prohibits any form of discrimination against any person on the basis of race, color, religion, sex, gender identity or expression, pregnancy, age, sexual orientation, marital or parental status, national origin, citizenship, genetics, disability, military/veteran status, or any other legally-protected status. This applies to the administration of and access to the College’s programs and activities; scholarship and loan programs; athletics; and in conditions of admission or employment. To learn more please see the Campus Non-Discrimination, Harassment, and Sexual Misconduct Policy at midmich.edu/titleix, and the Equal Employment Opportunity Policy at midmich.edu/eeo. Additionally, the College publishes an Annual Security that outlines safety and security initiatives, policies, protocols, and crime statistics and is available at midmich.edu/securityreport.

    Mid strongly encourages anyone who observes or experiences any acts of harassment, discrimination, inequitable treatment, or sexual misconduct to report the incident and seek assistance from one of the College’s Title IX/Civil Rights Coordinator as follows: Tricia Farrell, Director of Compliance & Ethics/Title IX/Civil Rights Coordinator, Harrison Campus Main Building Room 205, Mt. Pleasant Campus Doan Center Room 105, (989) 386-6622 x394, mfarrell@midmich.edu.

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