Danville Area Community College-SSS

Are you currently receiving a Pell Grant at DACC?*

YesNo

NOTE: A Pell grant is a form of federal financial aid based on financial need and other factors. If you are uncertain if you have received a Pell grant for the current academic year, please check with the DACC Financial Aid Office at (217) 443-8891.

FIRST GENERATION VERIFICATION

Did your mother/guardian graduate from a 4-year college with a bachelor’s degree?*

YesNo

Did your father/guardian graduate from a 4-year college with a bachelor’s degree?*

YesNo

DISABILITY VERIFICATION

Do you have a learning disability with official documentation on file at DACC?*

YesNo

Do you have a physical disability with official documentation on file at DACC?*

YesNo

INCOME VERIFICATION

PLEASE NOTE: If you are under 24 years of age, single, and do not have children- your parents or legal guardian must answer the following questions about themselves. You are considered a DEPENDENT student.

If you are 24 years of age or older, married, and/or have children- you must answer the following questions about yourself.
You are considered an INDEPENDENT student.

What is the total number of persons (including yourself) in your household? *

Income Question (Please only check one of the options below)*

What was your family’s total taxable income (not adjusted or gross) from the last calendar year? (Please fill below)My family did not file a federal income tax return last calendar year, but my family’s total income from the last calendar year was (Please fill below)My family had no taxable income during the last calendar year.

Total taxable income*

Total income if no federal income tax filed*

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 Danville Area Community College TRIO Student Support Services Program to obtain records or data pertinent to my participation from other sources, and to release information as required by law or the terms of the TRIO SSS grant to the grant-funding agency of the federal government.

Student Signature*

Please drag your mouse, finger, or stylus across the screen to sign

Date*

mm-dd-yyyy

Parent/Guardian Signature (if parent information is required above)*

Please drag your mouse, finger, or stylus across the screen to sign

Date*

mm-dd-yyyy