TRiO Student Support Services (SSS) Application

TRiO Student Support Services

Program Application

STATEMENT OF CONFIDENTIALITY:

The information contained in this application is for the purpose of determining the applicant’s eligibility for the Student Support Services (SSS) program. All information received is highly confidential.
FIRST: In order to be eligible for SSS you must meet at least one of the following criteria. Please indicate your eligibility status by checking one or more of the boxes.*

First-Generation College Student (neither one of your parents/legal guardian completed a four-year degree)Demonstrate Financial Need (if you're a Pell grant recipient, you are likely eligible)Have a documented physical or learning disability.
SECOND: Must not already have an AA/AS degree or higher, or have lower than a 2.0 GPA

THIRD: Must be a U.S. citizen or a U.S. permanent resident

FOURTH: Complete the entire online application and upload copies of all required documents. Please visit the Self-Service Student Portal Help Page at https://daytonastate.edu/help/ to access your Unofficial Transcript and Financial Aid Award Summary.
SSS Personal Information
DSC Student ID*
Social Security Number*
Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Gender*

MaleFemale
Home Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
College Email*
Please check preferred method of contact.*

EmailCell TextCell CallHome Phone
Ethnicity*

HispanicAm. Indian/Alaskan NativeAsianBlack/African AmericanWhiteNative Hawaiian/Other Pacific Islander
Marital Status*

Single, never marriedMarriedSeparatedDivorcedWidowed
SSS Program Eligibility
Does your mother have a 4-year degree?*

YesNoUnknown
Does your father have a 4-year degree?*

YesNoUnknown
Were you or are you currently in foster care?*

YesNo
Are you an emancipated or homeless student?*

YesNo
Are you a veteran?*

YesNo
Are you a U.S. Citizen?*

YesNo
Are you a U.S. permanent resident?*

YesNo
If Yes, please write RA#:
Did you complete the FAFSA?*

YesNo
Are you Pell grant eligible?*

YesNo
SSS Program Application
Supporting Documents

Images and PDF files are accepted! You may also submit these documents to our offices in the Baker Academic Support Center (Bldg. 500) to one of the TRiO Staff at one of the following locations: Room 110, Room 109, Room 103, or at the TRiO SSS Front Desk inside the ASC.

For a copy of your tax transcript, visit https://www.irs.gov/individuals/get-transcript and click Get Transcript ONLINE
Proof of Income

Upload a File

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Proof of Disability (if applicable)

Upload a File

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Essay

Please feel free to type your essay directly into our form, or you may upload your essay.

Topic: TRiO Student Support Services works with students to help them achieve their academic goals by providing academic tutoring, advising, transfer assistance, career planning, cultural experiences, financial assistance, and a sense of community. What are your career and academic goals? Why are you in college? Why are you applying to TRiO Student Support Services (SSS)? Please tell us how TRiO SSS will help you achieve your educational and career goals.
Please type your essay here or upload below. If you choose to upload your essay please type "essay uploaded" in this box.*
Upload your essay.

Upload a File

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Release & Liability Information
RELEASE/CONSENT TO USE PHOTOGRAPHS

Photographs of our participants may be included in our website or other college-approved media. We require your authorization to use any photos we take of you in order to do this.

Please read and sign if you agree to the following terms:

I hereby irrevocably consent to and authorize the use and reproduction by Daytona State College or any person or organization authorized by Daytona State College of any and all photographs, video tapes, or film which have been taken of me, both singularly and as a part of a group, without any compensation to me. All positives and negatives shall constitute solely the property of Daytona State College.
By typing your name, you agree to the release/consent to use photographs.

First NameLast Name
LIABILITY INFORMATION

The undersigned student joins in the release of Daytona State College, its trustees, officers, employees and agents from any and all liability or claims for losses or damages that the student may sustain while participating in travel activities sponsored by Daytona State College’s TRiO Student Support Services program. The undersigned expressly understands and agrees that Daytona State College, its trustees, officers, employees and agents assume no liability for the student’s participation in travel activities.
By typing your name, you agree to the liability information.*

First NameLast Name
STUDENT PARTICIPATION AND AUTHORIZATION AGREEMENT

I hereby agree to fully participate in all required activities, and attend all required meetings and workshops. I will commit myself to the Daytona State College TRiO Student Support Services Program until I graduate from Daytona State College. Failure to fully participate in required program events may result in removal from the TRiO Student Support Services program. I understand that admission into the program does NOT guarantee tutoring and/or grant aid.

My signature below indicates that the information given on this application is true and complete to the best of my knowledge. I also certify that the deliberate misrepresentation of the information may subject me to prosecution under applicable state and federal laws. Additionally, I understand that the information given herein is for the receipt of services funded by a Federal grant. The information provided may be disclosed to third parties for the purpose of verifying eligibility requirements, and in an effort to prevent fraud, waste and abuse in providing federal assistance.
By typing your name, you agree to the student participation and authorization agreement.*

First NameLast Name
You are now ready to complete your SSS application. Please click on the submit button below to send your application directly to an SSS Staff member. You may also print your application for your records or to submit in person.
Should be Empty:

TRiO Student Support Services

Program Application

STATEMENT OF CONFIDENTIALITY:

SSS Personal Information

SSS Program Eligibility

SSS Program Application

Release & Liability Information