Bluegrass Community & Technical-Lexington-SSS-Application Form

Student Support Services is a federal program funded through the U. S. Department of Education and sponsored by BCTC, an equal opportunity institution. Acceptance into the program is contingent upon meeting eligibility criteria and space availability. Information gathered on this application will be used to determine eligibility and will be held in strict confidence.

PERSONAL INFORMATION

Street Address

Street Address Line 2

CityState

Zip Code

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EDUCATIONAL INFORMATION

NEEDS ASSESSMENT

I could use help in the following areas:

ELIGIBILITY INFORMATION

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DEPENDENCY STATUS

FINANCIAL INFORMATION

*NOTE: Please only include your information if marital status is married, separated, or widowed, if you answered “Yes” to any of the above Dependency questions, or if you are 24 years old or older. Otherwise, please include the income of your parent(s)/guardian(s). Taxable income can be found on the Federal Income Tax Return. On IRS form 1040, see line 15.

STUDENT RELEASE

By signing below, I hereby verify that all the information provided on this application is accurate to the best of my knowledge. I hereby give permission for the BCTC Student Support Services program to review any available academic and financial aid records deemed necessary. I understand that this information is confidential and withholding information on this application or giving false information will make my application ineligible for admission to the BCTC SSS program.

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TRIO STUDENT SUPPORT SERVICES