Bluegrass Community & Technical-Danville-SSS-Application Form

  • TRIO Student Support Services
    Danville Campus
    Program Application

    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 
    • This is my*
    • Date of Birth*
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    • Are you Hispanic or Latino?*
    • Race*
    • Have you participated in other TRiO programs such as Talent Search or Upward Bound?*
    • Are you a US Citizen?*
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    • Eligibility Information 
    • Did either parent of which you resided with as a minor graduate with a bachelor degree?*
    • Do you have a documented disability?*
    • If yes, have you registered with the BCTC Office of Disability Support Services by submitting documentation of your disability?*

    • You may be required to submit written documentation by a qualified professional, physician, or state agency to verify your eligibility with Disability Support Services.

    • Educational Information 
    • High School Graduation Date or GED Completion Date*
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    • Current education status*

    • Academic Goals

    • Do you intend to complete an AA/AAS/Certificate or Diploma from BCTC?*
    • I intend to complete a(n)*

    • Needs Assessment

    • Select the areas you need help with
    • Family Information 

    • **YOUR APPLICATION WILL NOT BE PROCESSED UNTIL TAX FORMS ARE RECEIVED**

    • Marital Status*
    • Do you have children or other dependents (other than a spouse) who receive more than half of their support from you?*
    • At any time since reaching 13 years of age, were you an orphan, in foster care, or a ward of the court?*
    • Prior to reaching 18 years of age, were you an emancipated minor or did you have a court-appointed legal guardian?*
    • Are you serving on active duty (for other than training purposes) in the US Armed Forces?*
    • Are you homeless (you lacked a fixed, regular, adequate night-time residence) or are you at risk of becoming homeless?*
    • Family Income Information 

    • The federal government requires that SSS/TRiO have on file documentation of the family’s annual TAXABLE INCOME as reported on the federal tax form 1040, 1040A, or 1040EZ for the prior year.

    • Have you applied for financial aid at BCTC?*
    • Did you file a Federal Income Tax Return for the last calendar year?*

    • Note:  Taxable income can be found on the federal income tax return. On the IRS form 1040, see line 11b. On IRS form 1040A), see line 27 and Form 1040EZ, see line 6

    • 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.

    • Clear
    • Date*
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    • Submit 
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