Forsyth Technical Community College-SSS-Application Form

TRIO STUDENT SUPPORT SERVICES PROGRAM
Application

General Information
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
mm-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)

EmailTextPhone CallMail
Do you receive Financial Aid?

YesNo
Emergency Contact
Name

First NameLast Name
Phone
(999)999-9999
Relationship

Demographics
Gender

MaleFemale
Are you Hispanic/Latino?

YesNo
Race (check all that apply)

American Indian/Alaskan NativeBlack or African AmericanWhiteAsianNative Hawaiian/Pacific Islander

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

YesNo
Curriculum

Associate’s degree/University TransferAssociate’s degree/OtherDiplomaCertificate

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.

	Yes	No
Mother/Female Guardian
Father/Male Guardian

Income Verification
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

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

Browse Files

Cancelof
Option 3 - Statement including Family Taxable Income and Family Size: I/my parent or guardian filed an income tax return last year. (Respond to the two 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.

Personal Statement
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

Clear
Date

MonthDayYear
mm-dd-yyyy