*We will leave messages and/or text messages at the number provided unless otherwise instructed*

If you are 24 years of age or older, married, or have children, you are considered an Independent Student, and you will need to provide a copy of your tax return for the previous year.

If you are under the age of 24; not married; or do not have children, you are considered a Dependent Student, and you will need to provide a copy of your guardian’s tax return for the previous year.

Please take a moment to introduce yourself, describe your interest in the program, and how you think TRiO SSS can help you be successful

All student information at TRiO SSS is kept confidential and will not be released without permission.

TRiO SSS would like your permission to access and release your information for the following reasons:

1. TRiO SSS must report student progress and eligibility information at Gaston College and transfer institutions to the U.S. Department of Education to demonstrate program effectiveness when submitting annual performance reports and requesting renewed funding.
2. Gaston College Financial Aid will provide us eligibility information and Financial Aid Award information with your permission.
3. Academic progress monitoring and consultation with faculty and instructional support staff for the purpose of students’ continued academic success and possible intervention by program staff.
4. TRiO SSS will verify established accessibility for accommodations through Accessibility Services as needed.
5. We like to recognize student achievements. Do you grant permission to include your name or picture for program related publicity, exhibits or displays?

I certify that the information I have provided on this application is, to the best of my knowledge, true and correct. Furthermore, I understand that by applying for this program, I authorize the Gaston College TRiO Student Support Services Program to obtain records or data pertinent to my participation from other sources (including, but not limited to, Counseling, Student Financial Services, Accessibility Services Office, and Registrar’s Office), and to release information as required by law or the terms of the Student Support Services Grant, to the grant funding agency of the federal government. This information will be kept confidential and used only by TRiO SSS to verify my eligibility.

Gaston College TRiO SSS is asking you to provide information which includes private information under state and federal law. TRiO SSS is asking for this private information so that we can process your application for your admission to our program. This information will be used to evaluate your application for admission to determine whether you are an eligible candidate for admission into our program. You are not legally required to provide the information TRiO SSS is requesting, and you may refuse to provide some or all of the information requested. However, TRiO SSS may not be able to consider your application if you do not provide sufficient information. With some exceptions, unless you consent to further release of private information (see release of information), access to this information will be limited to the individuals involved in our admission process (including the Office of Student Financial Aid Services, Student Registration and Records, and Accessibility Services) and the advisors and clerical personnel of the program. However, federal and state laws do authorize release of private information without your consent to: school officials who have legitimate educational interests in the information; the U.S. Dept. of Education for the purposes of program compliance, audit or evaluation; the juvenile justice system, if you are a juvenile, and the information is necessary, prior to adjudication, to determine the juvenile justice system’s ability to serve you; an alleged victim of sexual assault, if you are the alleged perpetrator of the assault, and the release is of the result of a disciplinary proceeding against you related to the alleged crime; a court, grand jury, or state or federal agency, if the information is sought with a subpoena; appropriate persons in connection with an emergency, if necessary to protect your health or safety or the health or safety of others; if required by a court order, or permitted by other state or federal law.