Delgado Community College-SSS-Application Form

TRIO STUDENT SUPPORT SERVICES APPLICATION

Household Size (including self)*

Rows	Number of People
Adults
Children
Total Size of Family Unit

Family's Taxable Income, please retrieve taxable income information fromyour most recent federal tax returns*

$19,140$25,860$32,580$39,300$46,020$52,740$59,460$66,180
Do you qualify for a Federal Pell Grant?

YesNoUnsure

What is the highest level of education your parent(s)/guardian have completed?

Rows	High School	Some college or Associate's degree	4-year degree	Graduate Degree
Mother
Father

Do you have a documented disability for which you plan to seek accommodations while at Delgado?

YesNoUnsure
Have you participated in TRIO or following programs?

Talent SearchUpward BoundVeterans UBUB Math ScienceGear UP
Do you have access to a laptop and internet services?

YesNo
Date

MonthDayYear
Date
Parent’s or Guardian’s Signature (if under the age of 18)

Clear

Please tell us why you would like to be in TRIO

Please read the following descriptions of services offered by TRIO - Student Support Services and select those could benefit you.

Rows	Yes	No	Maybe
Writing Lab: Assistance with writing skills including APA format and the writing process.
Counseling: Counseling services are offered at no cost to students.
Financial Aid: Assistance with navigating aspects of financial aid including scholarships, grants, and the FAFSA.
TRIO Advisor: Additional support related to college success or student support.
Technology: TRIO offers access to computers & printing services at no cost.
Personal Support: TRIO will help provide guidance and support in all areas of balancing life and school. We also offer a food pantry.

To the best of my knowledge, the above information is correct. I understand that meeting the eligibility requirements does not guarantee that I will receive services.
Signature

Clear
Date

MonthDayYear
mm-dd-yyyy
Please return to Stacey Robertson, TRIO Director

Office
Student Services Center
Bldg. 2 Rm. 204, 2nd Floor

Email: srober2@dcc.edu

Phone: 504-671-6249

Fax: 504-671-6506