Georgia State University-Perimeter-Decatur-SSS

TRIO Student Support Services Participant Application

First Generation Verification Form
Did either of your parents graduate from college with a bachelor’s degree?*

YesNo
*If you select NO, you must complete the First Generation Verification Form.
Dear SSS Administrator:
This is to certify that I (student's name) _____________, am eligible to participate in the TRIO Student Support Services program at Perimeter College under the first generation provision of the project, since neither of my parents/legal guardians, (mother's name or legal guardian)___________ & (father's name or legal guardian) __________ completed a bachelor’s degree. By signing this document, it is acknowledged that this statement is true and correct to the best of my knowledge.
(student's name)*

First NameLast Name
(mother's name or legal guardian)*

First NameLast Name
(father's name or legal guardian)*

First NameLast Name
Student's Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy

Income Verification
As a federally funded program, TRIO SSS is required to provide documentation of a student's eligibility for the program to the U.S Department of Education. Please select an option below to use to verify your income eligibility.

Please complete only ONE of the sections below to indicate your chosen method of income verification. If you are classified an independent student, please use your own income information. If you are a dependent student, please use your parent/guardian's income information.
For FAFSA purposes, I am considered (check one):

IndependentDependent * (*must report parent's information in the sections below)
Did you or your parents (if dependent) file a Tax Return?

Filed a Tax ReturnDid NOT File a Tax Return
Filed a Tax Return
Please indicate your tax year filed:*
Taxable Income for the most recent tax year*
Form 1040, line 11b OR 15; Form 1040-SR, line 11b
Number of members in household included on this tax return?*
Student Signature:*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Parent Signature:

Clear
(required if dependent)
Date

MonthDayYear
mm-dd-yyyy
Did NOT File a Tax Return
In accordance with the eligibility requirements set forth by the U.S Department of Education, I hereby certify that NO Federal or State tax return documenting my income was filed with the IRS last year. I certify that my TOTAL INCOME from all sources last year was...*
... and the number of members in m household was....*
Student Signature:*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Parent Signature:

Clear
(required if dependent)
Date

MonthDayYear
mm-dd-yyyy
By signing this document section, I hereby certify that the information provided above is valid, non-fraudulent, and accurate.
If you choose to upload any official documents to verify your household income status, you can below. Official documents are 1040, 1040A, or 1040EZ Tax Form from the previous year signed and dated, a letter stating unemployment, TANF, SSI, Military Benefits, or a copy of your SAR (i.e., from your most current submitted FAFSA). Please note: If you are under 24 years old, you are considered dependent and must submit your parent/guardian's information. YOU MUST SUBMIT SOME INCOME INFORMATION in Option 1 or 2 or upload an official document! If NO income information is submitted, the application will be marked invalid and incomplete.

Browse Files

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Note: Please be assured your privacy is of the utmost importance to us. All submitted information (i.e., tax documents, financial information, medical documentation, etc.) will be used by TRIO Student Support Services (SSS) solely to determine eligibility. Your information will be kept confidential and stored in a highly secure location.

I understand that the TRIO SSS Staff adheres to all guidelines under the Federal Education Rights and Privacy Act (FERPA). I certify that the information provided on this application is correct to the best of my knowledge. I authorize TRIO SSS to access my financial, demographic, and academic information as a Perimeter College student. TRIO Student Support Services also has permission to use my data in Georgia State University, and the U.S. Department of Education reports.
Student Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy