In order to be considered eligible for the TRIO STEM-H, you must meet at least one of the following criteria:

• Low income (Use Current Family Income Chart)
• First generation college student
• Have a medically documented disability
• Demonstrate an academic need for services

To complete the STEM-H application and admission process, the following information must be provided to the STEM-H office, located in Milledge Hall, room 126 or 125 or scan and email the forms via UGA sendfiles to lag49250@uga.edu or upload the required documents below:

• Tax forms (1040A, 1040 or 1040EZ) for previous year. (If you are under 24 years of age, you must submit your parents tax forms)

OR

• An official document that verifies your current household income status (i.e. letter stating unemployment, TANF, SSI, etc. benefits) and a copy of your financial aid form (i.e. your FAFSA) that you have submitted to the Federal Education Department that has your income information included.
• Disability Documentation must be provided by an appropriate Professional or State Rehabilitation Office

If accepted into UGA TRIO STEM-H program, I, (Student Name),

Affidavit of Truth Statement and Release of Information

My signature bears witness that the information provided on this application is true to the best of my knowledge. I also understand that(1) omissions or misrepresentations on my part will automatically invalidate consideration by, acceptance to, or continuation in TRIO STEM-H; (2) An additional appointment and assessment is necessary to determine my acceptance into TRIO STEM-H; (3) Completion of thisform does not guarantee that I will be selected as a TRIO STEM-H Scholars; and (4) If I am not an active participant in TRIO STEM-H, my status can be changed to inactive without my notification.

Contact Information

UGA TRIO STEM-H
Services
Milledge Hall

Athens, GA 30602
Office 126 or 125

Phone: (706) 542-7242 3
Email: triosss@uga.edu
Website: www.dae.uga.edu

Declaration of Household Size and Income

Look at the following tables of family size and income levels. If you are a dependent, please circle the number of members of your family living at home with you and your parents. Next, circle the income immediately higher than your family's estimated taxable income. For example, if you live at home with mom, dad, and three siblings, your family size is six. If your family's taxable income was $50,940, you would select the next highest amount, i.e. $51,885

NOTE: If you were claimed as a dependent, a parent or legal guardian must sign this form. If you are independent, please sign below.
PARENTS: You can reach out to Latricia at lag49250@uga.edu to request the form be sent as an attachment and you can scan (take a picture) and email the document to lag49250@uga.edu and please leave the 810# section blank.

TRIO STEM-H
Milledge Hall, Room 126 or 125
University of Georgia
lag49250@uga.edu
(706) 542-7242

*WARNING: Falsifying information on this form is federal offence, punishable by a fine, or imprisonment, or both.