Trio application

– Step 1 of 2

Personal Information

Social Security number

SC4 ID #

All SC4 ID numbers start with a “0”

Name *

First

Middle

Last

Preferred name or nickname

A preferred or nickname name cannot:

misrepresent a person’s identity and/or misappropriate the identity of another person or organization;
be used in attempt to avoid a legal obligation;
be used if its appearance on college records would be harmful to the reputation or interests of the college;
be derogatory, obscene, convey an offensive message, or be otherwise inappropriate.

Local address *

Address Line 1

City

State

Zip Code

Permanent address same as above *

Permanent address *

Address Line 1

City

State

Zip Code

Home phone *

Mobile phone *

Work phone

SC4 email address *

Personal email *

Birth date *

For example 01/01/2001

Gender *

Male
Female

Race *

America/Alaska native
Asian
Black/African-American
Hawaiian/Pacific islander
White/Caucasian

Ethnicity *

Hispanic/Latino
Non-Hispanic/Non-Latino

U.S. Citizen or Resident Alien *

Eligibility

Did your father graduate with a bachelor’s degree from a four-year college or university? *

Did your mother graduate with a bachelor’s degree from a four-year college or university? *

Which parent did you regularly reside with and receive support from during your childhood? *

Mother
Father
Both mother and father
Neither mother nor father

Disability status: *

Documents on file with SC4 Disability Services *

Did you complete high school? *

Yes
GED
Neither

Participation Requirements

Maintain a 2.0 GPA
Attend at least one (1) Success Seminar each semester
Attend at least one (1) Cultural Event or Campus Visit per academic year
Meet with TRIO Advisor once per month or more as requested

College attendance

Have you previously attended any other colleges? *

Name of college *

Dates of attendance *

Have you previously attended a second college? *

Name of college (second) *

Dates of attendance (second college) *

Have you previously attended a third college? *

Name of college (third) *

Dates of attendance (third college) *

What is your current enrollment status at SC4? *

First year, never attended (0 credits completed)
First year, attended before (1-31 credits completed)
Second year, sophomore (32 or more credits completed)

Program of study

What is your SC4 goal(s)? *

Certificate
Applied associate degree
Transfer associate degree
Transfer credits only

Services you would like from TRIO? *

Academic advising
Career counseling
Employment assistance
Financial aid application assistance
Mentoring
Support/motivation
Study skills
Tips for college success
Transfer plan/university trips
Tutoring
Other

Other, please explain *

Do you intend to transfer? *

Where *

Background information

Are you married? *

Do you have children or other dependents (other than spouse) who receive more than half support from you? *

At any time since reaching age 13, were you an orphan, in foster care or a ward of the court? *

Prior to reaching age 18, were you an emancipated minor or did you have a court-appointed legal guardian? *

Are you younger than age 18 and have no parent or guardian? *

Are you homeless (i.e., you lack a fixed, regular and adequate night time residence) or at risk of being homeless? *

Are you facing any barriers that could potentially affect your academics? *

Please explain any barriers that could potentially affect your academics *

Financial Aid Information

Check all that apply *

Applied for financial aid
Ineligible for financial aid
Receiving financial aid
Never applied for financial aid

Annual income levels for TRIO programs – Student Income Affidavit

Name *

First

Middle

Last

Social Security number *

Date *

This form serves as a declaration of taxable family income received in the last tax year, in lieu of a federal income tax return.

The income of all family members living in the household must be included. By your signature, you indicate that all information is true and correct to the best of your knowledge.

Please do not sign in this box if you were a dependent or earned income.

TRIO Applicant:

If you had no taxable income during the last tax year, please sign here.

Student's (applicant) signature *

Type your full legal name in the box provided as an electronic signature for this Application for Admission.

Were you claimed as a dependent during the last tax year? *

If yes, by whom? *

What is the number of people living in your household, including yourself, as reported on your latest tax forms? *

What is your 2023 family’s yearly TAXABLE income (not gross or adjusted gross income):

(Taxable Income can be found on the Federal form(s): 1040-Line 11b)

Taxable income bracket: *

$22,590 or less
$22,591 to $30,660
$30,661 to $38,730
$38,731 to $46,800
$46,801 to $54,870
$54,871 to $62,940
$62,941 to $71,010
$71,011 to $79,080
$79,081 and more

Signature *

If applicant is a dependent, parent or guardian signs here.

The figures shown under family income represent amounts equal to 150% of the family income levels established by the U.S. Bureau of the Census for determining poverty status. The poverty guidelines were published by the U.S. Department of Health and Human Services in the Federal Register on January 11, 2024.

Effective January 11, 2024 until further notice.

Signatures and verification

By signing this application, I attest that all the information on this application is true. Moreover, I authorize the release of the applicant official academic records to TRIO – Student Support Services, understanding that the information in these records will be used only to assess the applicant need for program services, discern the applicant educational progress, evaluate the effectiveness of the program activities and fulfill program-reporting requirements. You and your guardian may have to come in and sign the application in person.

Type your full legal name in the box provided as an electronic signature for this Application for Admission.
Please understand that you and your guardian may have to come in and sign the application in person.

Student's (applicant) signature *

Date *

Parent of legal guardian's signature (if applicable)

Date

Signature

Clear Signature