PART 1: PERSONAL DATA

PART 2: ETHNICITY/RACE/CITIZENSHIP GROUP

PART 3: MARITAL STATUS

PART 4: EDUCATIONAL INFORMATION

PART 5: FIRST GENERATION VERIFCATION

PART 6: DISABILITIES VERIFICATION

PART 7: INCOME VERIFICATION

Verification requirements for TRiO SSS vary depending on whether students are Independent or Dependent. A list of federal criteria for independent student status is available at the Department of Education Dependency Status Please click the link below to complete the TRiO SSS 2020 Income Eligibility Form.

TRiO SSS Income Eligibility Form

PART 8: WORKSHOPS AND SERVICES

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.

Program Name: Student Support Services

Program Year: 2024-2025

Program Location: La Junta, Colorado

I freely and voluntarily participate in any programs offered by the Student Support Services department of Otero College, and in which I do release the college officers, administrators, employees, representatives and/or agents, and their heirs, successors, and assigns, liable in any way what so ever for any injury, or damage, or loss of property sustained by myself or persons other than my arising out of, or in connection with, or due to negligence, fault, or otherwise during any part of my participation in the aforementioned program.

For the same consideration and without conflict in the foregoing, voluntarily and knowingly, I hereby release and discharge Otero College officers, administrators, employees, representatives and/or agents, and their heirs, successors, and assigns, both in their official and individual capacities jointly and severally, from any actions, causes of action, claims, demands, damages, costs, and expenses on account or in any way growing out of any and all loss of personal property, or injury, as the result of any accident, delay, or irregularity which may be caused either in whole or in part by any defect in any vehicle, airplane, vessel, or negligent operation there of and through any act, error, or omission, or default of any company or person, or by reason of the conditions or use of any real or personal property while I am en route to, or from or participating in the program or occasioned by it.

I further promise to bind myself, and all my heirs, administrators, and executors, to identify and forever hold harmless Otero College, their officers, administrators, employees, representatives and/or agents against loss, damage, or expense from any and all claims, demands, actions, or causes of action that may occur while en route to, or from, of participating in the program or any activity relating or occasioned by it.

I have read this release and understand all its items and execute it voluntarily and with full knowledge of its significance.

I hereby consent to, and authorize Otero College and the Colorado Community College System the use and reproduction of any and all photographs, digital images, or video/audio streaming/recordings made of me for use by Otero College, its employees, officers and agents, and the right to copyright and/or use, reuse and/or publish, republish photographs, digital images, or video/audio streaming/recordings in conjunction with my name.

I also give permission for the photographs, digital images, or video/audio streaming/recordings to be used in their entirety and/or edited versions as deemed necessary by Otero College including use of images on college websites.

Furthermore, permission is also given for the photographs, digital images, or video/audio streaming/recordings to be used by Otero College at any time in the future without further clearance from me.

I understand that these photographs, digital images, or video/audio streaming/recordings may be used for marketing purposes (including websites) by Otero College.

I have read the foregoing release, authorization and agreement, before signing below, and warrant that I fully understand the contents thereof.

So that the photographer/videographer can identify me correctly, my appearance can be distinguished by (describe identifying hairstyle, jewelry or piece of clothing.)

As a TRiO participant we ask that you make a commitment to yourself and the TRiO program so you may fully benefit from the service TRiO has to offer. Students who have participated in the TRiO SSS program are 3 times more likely to graduate with a degree. Our staff will work closely with you to provide comprehensive services.

Transfer Vs. Non-Transfer Degrees:

AA (Associate of Arts) or AS (Associate of Science) degrees are transferrable degrees. These degrees will more than likely allow you to transfer over at a junior status (some exceptions apply).

AGS (Associate of General Studies) degree – only core classes will transfer.

AAS (Associate of Applied Science) – this degree will be examined course by course at the university and it is possible for you to transfer below junior status with this degree.

Financial Aid:

A student can be placed on financial aid probation and/or suspension if they receive any of the following:

D/F – does not count as a passing grade, lowers GPA, counts as attempted hours which use financial aid dollars.

W – does not count as a passing grade, counts as attempted hours which use financial aid dollars.  The “W” cannot be removed from your transcript.

I understand the program expectations and accept my responsibilities as a participant in Student Support Services.

I agree to follow through with this plan and notify my advisor when I accomplish this plan. I also agree to keep my advisor informed about any obstacles that I encounter so additional assistance can be provided.