Forsyth Technical Community College-SSS-Application Form

TRIO STUDENT SUPPORT SERVICES PROGRAM
Application

Name

First NameMiddle InitialLast Name
Student ID #
T-Shirt Size
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearmm-dd-yyyy
Forsyth Tech Email Address
example@example.com
Alternate Email Address
example@example.com
Cell Phone
(999)999-9999
Home Phone
(999)999-9999
Preferred Method(s) of Contact (Check ALL that apply)
Do you receive Financial Aid?
Emergency Contact
Name

First NameLast Name
Phone
(999)999-9999
Relationship

Gender
Are you Hispanic/Latino?
Race (check all that apply)

Enrollment Status: Are you currently enrolled at Forsyth Tech or accepted for enrollment in the next academic term?
Curriculum

First Generation Status: Did either parent or guardian with whom you resided have a bachelor’s degree prior to you turning 18? *Please provide this information only for those parents/guardians living in your former household.

Rows	Yes	No
Mother/Female Guardian
Father/Male Guardian

Please complete only 1 of the 3 sections below. Check the appropriate box to
indicate your chosen method of income verification.

If you are an independent student, please use your own income information.
If you are a dependent student, please use your parent/guardian’s income information.
Option 1 - Income Tax Return Included: I am including my/my parent or guardian’s income tax return for last year with this application.

Browse Files

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Option 2 - Financial Aid Application Included: I am including my financial aid application with this application.

Browse Files

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Option 3 - Statement of Income and Family Size (Respond to the three questions below.)
The number of individuals currently living in my household and/or claimed as dependents (including myself) is
My/my parent or guardian’s taxable income for last year was
(Form 1040 line 43 or Form 1040A line 27). Please note that taxable income is different from gross or net income.
Option 3 – Statement of Income and Family Size

Please answer the questions below to provide information about your household size and income.
The number of individuals currently living in my household and/or claimed as dependents (including myself) is:
Does any of your support come from Public Assistance?
Which statement applies to you?
Enter the appropriate income amount below:
- If you or your parent/guardian filed a federal income tax return, enter the taxable income reported on Form 1040, Line 15.
- If you or your parent/guardian did not file a federal income tax return, enter your total income for the last calendar year.
Income Amount: $
Important: If a federal tax return was filed, please enter taxable income (Form 1040, Line 15), not gross income or net income.
Note: Generally, you are considered an independent student if you meet at least one of the federal criteria used on the FAFSA (e.g., age 24 or older, married, graduate/professional student, veteran/active-duty service member, has dependent children, was in foster care/under legal guardianship, or meets certain other federal criteria). Students who do not meet these criteria are generally considered dependent. If you are unsure, contact the TRIO SSS office for assistance.

Please write a short statement about your educational goals and career aspirations. In your statement please also tell us about the services or support you may need in order to achieve academic success and/or graduate.
I would like to participate in the TRIO Student Support Services Program and receive the free services provided.

I hereby certify that the information provided in this application is accurate and complete to the best of my knowledge.

I give consent for the TRIO Student Support Services Program to access all of my student records at Forsyth Technical Community College, including both academic and financial records.

I understand that this information is confidential and will only be used for the purposes of my application to this program.
Applicant signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearmm-dd-yyyy