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  • York Technical College-Rock Hill-STEM-SSS

     Program  APPLICATION 

  • Space is limited for new applicants and applications are processed on a first-come, first-served basis. A completed application with the required documentation (proof of income and/or disability) should be submitted for review to determine eligibility. Otherwise, it will not be considered, unless the student has submitted proof of income and/or disability to another college office. If the student has not, the following is considered acceptable proof: a notarized statement regarding family’s income from student (if independent) or student’s parent/legal guardian, verification of family income from another governmental source, a signed financial aid application, or a signed U.S. or Puerto Rican income tax return; and a statement from the Special Resources office, if services are received from them.  
     

    • Section I.  Demographic Information  

    • Note: If you gave us a different name while enrolled for services through this project, please provide that name (or those names) below. This will help ensure that we retrive the correct file.

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    • Section II.  Eligibility  

    • Note: Taxable income can be found on the Federal Tax Return (Form 1040, line 11b) ; and the number of exemptions (Form 1040 line 6d and 1040A line 6d).


    • Section III. Services 
    • Section IV.  Personal Statement  

    • AUTHORIZATION AND CERTIFICATION OF INFORMATION  
        
      By giving my signature below, I certify that all information given is accurate and complete.  I also authorize Student Support Services personnel to obtain and use the following information about me as needed to document the service(s) provided to me: 

      1. A copy of my records from the Financial Aid Office; 
      2. A copy of my transcripts and related information from the Registrar’s Office; and/or 
      3. Other kinds of documentation, such as reports from counselors/advisors, records of my participation in other public assistance programs, etc. 

      Furthermore, in the event I request assistance with a personal problem, I hereby authorize SSS personnel to discuss my personal information with other persons whose involvement is considered necessary for and consistent with providing the assistance I have requested.  Except as authorized herein, SSS personnel agree to maintain the confidentiality of my student information, in accordance with the Family Education Rights and Privacy Act (FERPA). 

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