Yavapai Community College-SSS-Application Form

SSS TRIO Application
To make completing this application easier for you, we’ve enabled a SAVE feature. This allows you to send a link to your email so you can return to your application. Fill out as much as you can, then click SAVE, click “Skip Create an Account”, and enter your email.
Para facilitarle la tarea de completar esta solicitud, habilitamos la función GUARDAR. Esto le permite enviar un enlace a su correo electrónico para que pueda regresar a su solicitud. Complete todo lo que pueda, luego haga clic en GUARDAR, haga clic en "Omitir crear una cuenta" e ingrese su correo electrónico.

Independent Student
Please provide information from the most recent tax year.
Tax Year*
Tax Year*
ie) 2021
State of Residence*
Number in household (yourself and spouse/dependents, if applicable)*
Taxable Income (NOT Gross Income) from most recent tax year forms (If married, include spouse’s income.)*
If taxable income is unknown, please explain*

Dependent Student
Please provide information from the most recent tax year.
Tax Year*
Tax Year*
ie) 2021
Dependent Student
Student State of Residence*
Student Taxable Income (NOT Gross Income) from most recent tax year forms.*
If taxable income is unknown, please explain*
Parent Information
Parent(s) State of Residence*
Number in household (yourself and spouse/dependents, if applicable)*
Taxable Income (NOT Gross Income) from most recent tax year forms (If married, include spouse’s income.)*
If taxable income is unknown, please explain*
Parent 1*

First NameLast Name
Parent 2

First NameLast Name

Signature
The information submitted is correct to the best of my knowledge. I understand that I am granting permission for SSS staff to access my student information, including academic progress requests from instructors. This information will be used to facilitate my academic success, and all Yavapai College confidentiality practices will be followed. I have read and agree to follow the SSS TRIO Contract of Participation.

SSS TRIO Contract of Participation

Participation in the Student Support Services (SSS TRIO) Program is offered to only a limited number of students each year and should be considered an opportunity to excel. By signing below, I acknowledge that I am committing myself to the following SSS Program requirements and that lack of participation may result in dismissal from the SSS TRIO Program.

On-going expectations as applicable:
- Read and respond to all SSS communications including, YC scholar email, texts, and voicemail.
- Meet with my SSS advisor at least two times per semester to discuss:
  - my academic progress and plan
  - career exploration
  - transfer options and information
  - financial aid and scholarships
- Meet with my SSS advisor before withdrawing from a course, school, or this program.
- Contact the SSS office when I need answers regarding financial aid.
- Attend workshops or cultural/educational activities that meet my academic needs
- Seek out and participate in tutoring services as needed. Meet with assigned tutors.
- Seek out and participate in mentoring opportunities.
- Give feedback on surveys, questionnaires, etc., to improve program services and activities.
College Photo and Videotape Policy, as stated in the Yavapai College Catalog, applies to SSS TRIO events. Photographs might include students participating in SSS TRIO events and might be used in college publications and publicity.
Signature*

Clear
Date*

MonthDayYear
MM-DD-YYYY