Laurel Ridge Community College-SSS-Application Form

LAUREL RIDGE COMMUNITY COLLEGE TRIO STUDENT SUPPORT SERVICES APPLICATION
Thank you for your interest in TRIO at Laurel Ridge Community College! We look forward to reviewing your application. All information listed in this application are confidential and are used to determine eligibility for acceptance into TRIO. Please fill out the application fully and answer all questions. After we review your application, we will notify you of next steps in your Laurel Ridge student email. Please reach out to trio@laurelridge.edu if you have questions.

I consent to the disclosure of my FAFSA data to the TRIO program team for the purpose of determining eligibility for this program.
- Student Demographic Information
- Name*
  
  First NameLast Name
- Social Security #*
  999-99-9999
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Phone*
  (999)999-9999
- Date of Birth*
  
  MonthDayYear
  mm-dd-yyyy
- Laurel Ridge ID#*
- Laurel Ridge E-Mail*
  example@example.com
- Gender*
  
  MaleFemaleOther
- Marital Status*
  
  SingleMarriedDivorcedWidowed
- Citizenship Status*
  
  U.S. CitizenPermanent ResidentDACAOther
- Are you Hispanic/Latino?*
  
  YesNo
- Is English your first language?*
  
  YesNo
- If no, what is your first language?
- Race (Please check ALL that apply)*
  
  American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or other Pacific IslanderWhite
- In accordance with federal regulations, a student must meet one of the following criteria to be eligible for program services:
  - A first generation college student (neither parent has a bachelor’s degree)
  - Low income (verified by a TRIO staff member and based on federal low-income guidelines)
  - Have a documented learning, physical or emotional disability
- Does your parent #1 have a bachelor’s degree?*
  
  YesNo
- Does your parent #2 have a bachelor’s degree?*
  
  YesNo
- With which parent did you primarily reside/receive support during childhood?*
  
  Parent #1Parent #2BothNeither
- Do you have a documented learning, physical or emotional disability?*
  
  YesNo
- If yes:
- Have you registered with the Office of Accommodations and DisabilityServices?*
  
  YesNoNot applicable
- Do you plan to seek/use academic accommodations at Laurel Ridge?*
  
  YesNoNot applicable
- Academic Information
- Did you earn any of the following:*
  
  High School DiplomaGED/HS equivalencyNeither
- Have you ever taken college classes at another institution?*
  
  YesNo
- Do you have an associate degree or higher?*
  
  YesNo
- Laurel Ridge program of study*
- HS/College GPA*
- Number of credits in which you are currently enrolled:*
- Number of credits you have completed:*
- Do you plan to transfer to a 4-year school?*
  
  YesNo
- If yes, to where?*
- What is your anticipated date of graduation (semester and year)?*
- How did you hear about TRIO?*
- Permission and understanding statement
  
  I give TRIO my permission to access my educational records and other materials necessary for participation in the TRIO Program. Furthermore, I understand that all my records are kept confidential and in accordance with Federal, Commonwealth of Virginia, and Laurel Ridge Privacy Laws. I certify that the above information is complete and accurate to the best of my knowledge. I give TRIO personnel permission for the following:
- To release name for recognition (scholarships, etc.):*
  
  YesNo
- To take my picture and use for recognition and advertising:*
  
  YesNo
- I also understand that TRIO SSS is an application based program and ultimate admission is up to the discretion of the TRIO program team. I understand that TRIO is only available to a limited number of students, and precedence for spots may be given to students based on number of credits, program of study, academic history, academic need, etc.
- Student Signature*
  
  Clear
- Date Signed*
  
  MonthDayYear
  mm-dd-yyyy
- Financial Eligibility Documentation
  
  If you/your family filed income taxes last year, what was your TAXABLE INCOME?
  
  It is very important that you indicate TAXABLE income and not total income or adjusted gross income.
  
  The best source for this information is your 2024 Federal Tax return. Taxable income is reported on:
  - Form 1040, line 43
  - Form 1040A, line 27
  - Form 1040EZ, line 6
- Please list your total household TAXABLE INCOME for 2024*
- Number of people living in your household (for tax purposes) including yourself during 2024*
- Household income from other sources*
- Please select all that apply:*
  
  Social SecurityUnemploymentTrade ActRetirement BenefitsVeterans Affairs BenefitsVocational RehabilitationNone of the above
- If you are an independent student for financial aid purposes, please identify as being one or more of the following:*
  
  At least 24 years oldA parentA veteranAn orphan or ward of the courtHave a bachelor’s degreeNone of the aboveOther
- I hereby certify the information I have furnished regarding the size of my family and taxable income is true to the best of my knowledge and hereby grant permission for Laurel Ridge TRIO Student Support Services to have access to my official records in order to complete my application. A parent or guardian’s signature is required for students classified as dependent for financial aid purposes. For a student to be considered “independent,” he or she must meet one of the qualifications listed above. Your application will not be complete without the necessary signature(s) and date(s).
- Student Signature*
  
  Clear
- Date Signed*
  
  MonthDayYear
  mm-dd-yyyy
- Parent or Guardian Signature*
  
  Clear
  (Needed if student is a dependent of parent for financial aid purposes)
- Date Signed*
  
  MonthDayYear
  mm-dd-yyyy
- Parent or Guardian Name*
  
  First NameLast Name
- Parent/Guardian e-mail*
  example@example.com
- Please rate your familiarity or comfort level with each of the below resources. Circle the number that best describes your level of comfort/ familiarity. “1” is “very uncomfortable / unfamiliar.” “5” is “very comfortable/familiar.”
- Understanding and applying for financial aid?*
  
  12345
- Declaring a major or degree that is right for me:*
  
  12345
- Choosing which classes to enroll in each semester:*
  
  12345
- How to access tutoring on campus or online:*
  
  12345
- How to access financial resources on campus (like the food pantry, emergency financial assistance, gas cards, etc.):*
  
  12345
- Where to go for help if I am feeling overwhelmed:*
  
  12345
- How to talk to my professors if I need help or don’t understand something in class:*
  
  12345
- Choosing a career that is right for me:*
  
  12345
- Applying to transfer to a 4-year school:*
  
  12345
- While at Laurel Ridge, I would like to achieve the following goals:*
- After I complete my coursework at Laurel Ridge I plan to:*
- When I look ahead 10 years, this is how I see my life:*
- Some strengths that will make me a successful student are:*
- My greatest sources of personal and emotional support are: (ex: parents, spouse, siblings, friends, coworkers, teachers, etc.)*
- My biggest challenges in being successful at Laurel Ridge will be:*
- The area I could most use TRIO’s assistance with is:*
- Why are you interested in joining TRIO and howdo you hope TRIO can help you at Laurel Ridge?”*

LAUREL RIDGE COMMUNITY COLLEGE TRIO STUDENT SUPPORT SERVICES APPLICATION