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  • TRiO STUDENT SUPPORT SERVICES (SSS)
    PARTICIPANT APPLICATION ELIGIBILITY FORM
    LAWSON STATE COMMUNITY COLLEGE
    BESSEMER CAMPUS
    NOTE: Program participants must meet certain requirements set forth by the Department of Education. The following information will be used to determine your eligibility. All information will be held in confidence by the project staff. PLEASE COMPLETE ALL INFORMATION REQUESTED. (Incomplete applications will not be considered.)
    • PERSONAL DATA 

    • PERSONAL DATA

    • Gender
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    • Marital Status*
    • Citizenship Status*

    • Race/Ethnicity*

    • FIRST GENERATION VERIFICATION INFORMATION 

    • FIRST GENERATION VERIFICATION INFORMATION (PARENT(S) EDUCATION)

    • Does your mother (or female legal guardian) have a four-year college/university degree?*

    • You do not meet the criteria for eligibility. Please contact the Director for an interview to evaluate your eligibility at 205-929-3518.

    • Does your father (or male legal guardian) have a four-year college/university degree?*

    • You do not meet the criteria for eligibility. Please contact the Director for an interview to evaluate your eligibility at 205-929-3518.

    • If yes, what college/university did they graduate from?

    • DISABILITY VERIFICATION 

    • DISABILITY VERIFICATION

    • Do you have a documented disability?*

    • You do not meet the criteria for eligibility. Please contact the Director for an interview to evaluate your eligibility at 205-929-3518.

    • Is the information documented with Lawson State Community College’s office of Disability Services?*
    • Is the information documented with a Medical/Mental Health Professional?*
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    • FINANCIAL AID INFORMATION 

    • FINANCIAL AID INFORMATION

    • Are you receiving any type of financial aid?*

    • You do not meet the criteria for eligibility. Please contact the Director for an interview to evaluate your eligibility at 205-929-3518.

    • If no, have you applied for financial aid?*
    • If yes, what type:*
    • Have you been advised of all financial programs on campus?*
    • Is the aid that you are currently receiving sufficient to meet your financial need at this time?*
    • INCOME VERIFICATION 

    • INCOME VERIFICATION

      Please note all financial information is confidential.  Documentation of family income is required for a student to be considered for participation in the TRIO Student Support Services program.  If you are still claimed by your parents on their tax returns, please email their most recent Tax Return (1040) and Other forms of income verification documentation: (ADC verification or documentation of government Issued funds) for the year indicated to lharris@lawsonstate.edu or sssbessemer@lawsonstate.edu.

      Taxable Income is not the same as adjusted gross income, taxable Income is determined after deductions have been taken for your gross income.

      Dependent Student (You Live with and/or supported by your parent(s) or guardian(s)

    • Are you a dependent Student?
    • Please indicate the year the following income information is referencing:
    • Did your parents file taxes last year?
    • If your parents did not file Income Taxes what is their source of income?

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    • Please note all financial information is confidential.

      INDEPENDENT STUDENT SECTION (An Independent student is defined as: a student who has dependents that receive more than half of their support from you, married, active military or 24 years old)

    • Are you a independent Student?
    • Please indicate the year the following income information is referencing:
    • If you are an independent student, did you file taxes for last year?
    • Since taxes are not being filed what was your source of income source?

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    • If you are no longer claimed on your parents tax return, please email your Tax Return, Tax Transcript or any other income verification documentation for the year indicated to lharris@lawsonstate.edu or sssbessemer@lawsonstate.edu.

      Please note all financial information is confidential.

    • ACADEMIC NEEDS 

    • ACADEMIC NEEDS

    • Do you meet at least one of the academic needs below? (Check all that apply)*
    • ACADEMIC SUPPORTIVE SERVICES NEEDED (Check all that apply)*
    • STUDENT EDUCATIONAL TRACK 

    • STUDENT EDUCATIONAL TRACK

    • Transferring to a 4 year college/university*
    • Which of the following Degree seeking?*
    • Are you seeking a certification?*
    • EDUCATIONAL INFORMATION 

    • EDUCATIONAL INFORMATION

    • Academic Classification*
    • Are you currently enrolled at LSCC:*
    • Are you a College graduate?*
    • Transient Student*
    • Have you ever been a participant in a TRIO program?*
    • Which program?*
    • PARTICIPANT EXPECTATIONS 

    • PARTICIPANT EXPECTATIONS

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    • I understand and agree to strive to maintain a 2.0 GPA and compete all registered classes.  If at any time I experience difficulty in any of those classes, I will make an appointment with TRIO SSS staff to discuss my options and access my  recourses to improve my grads(s).  I will participate in any recommended supportive serves ( Tutoring, counseling, mid-term evaluation, etc.) designed to improve my college experience and academic journey.  Any changes in major or withdrawals will be discussed with TRIO Staff prior to finalizing my decision.  Lastly I understand and agree to participating in 3 workshops, cultural enrichment activities or college tours each semester.

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    • RELEASE OF INFORMATION 

    • RELEASE OF INFORMATION

      I authorize Trio SSS staff to gather information concerning all academic and financial aid records from the school(s) I have attended or presently attend.  I further authorize TRiO SSS Staff to make copies of all academic and finical aid records with the understanding that this information is used to help determine my eligibility for SSS and is kept strictly confidential.   

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    • IMAGE AND VOICE RELEASE 

    • IMAGE AND VOICE RELEASE

      I further authorize Trio SSS Staff to use my image and/or likeness (photos and voice) for the programs promotional purposes (brochures, videos, social media pages, printed materials, etc.)

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