Bowling Green State University-SSS-Application Form

TRIO STUDENT SUPPORT SERVICES APPLICATION

*Per the Family Educational Rights and Privacy Act, information in this application is confidential—we will protect your sensitive personal data

**Please DO NOT put SSN on form. An SSS admin will contact you for this information.

Please fill out the application completely. Incomplete applications will not be processed.

Eligibility
In accordance with federal regulations, a student must meet one of the following criteria to join TRIO Student Support Services:
- A first-generation college student (neither parent has a Bachelor’s degree)
- Limited income (verified by a SSS staff member)
- Have a documented learning or physical disability
First-Generation Status

Note: this means neither parent has a bachelor degree. ONLY custodial parents are counted for the purposes of first-generation status. If you do not know due to being an orphan or aged out of foster care, mark “Yes.”
Are you a first-generation student?*

YesNo
Accessibility Status
Do you have a disability?*

YesNo
Have you registered a documented physical or learning disability with BGSU Accessibility Services?*

YesNoNot Applicable
“No” means you have a disability, but have not registered it. You must register your disability with BGSU Accessibility Services to meet this SSS eligibility criteria
If you are admitted to BGSU TRIO Student Support Services:

We will require the following commitment from you:
• I AGREE and understand that I may be pre-registered for SSS designated courses.
• I WILL meet with my SSS advisor at least twice a semester.
• I WILL participate in tutoring sessions as needed.
• I WILL meet with the SSS Math, Writing, and Reading/Study Skills Specialists as needed.
• I WILL participate in SSS financial aid and career development workshops and events.
• I intend to enroll full time and graduate within 5 years of my first BGSU enrollment.
• I WILL set goals with my SSS advisor that lead to my planned graduation from BGSU.
I agree to these requirements as shown by my signature below:
Print Name*

First NameLast Name
Signature*

Clear
Today's Date*

MonthDayYear
mm-dd-yyyy
FERPA Release (optional)

I give BGSU TRIO Programs permission to share information with the following people (give names and relationship to you)

	Name	Relationship
1
2
3

Student Signature

Clear
Today's Date

MonthDayYear
mm-dd-yyyy
CORE ELIGIBILITY INDICATORS
REQUIRED: Financial Eligibility Verification
Note: Refer to your prior year TAXABLE income (not total income or adjusted gross income) when answering the next two questions. The best source for this information is last year’s Federal Tax Return Refer to the following chart to understand TRIO income eligibility: https://www2.ed.gov/about/offices/list/ope/trio/incomelevels.html
Number of people in your household, includingyourself, for tax purposes: *
If you and/or your family filed income taxes last year, what was your combined TAXABLE INCOME? (Make sure to mark the lowest amount that applies to ensure income eligibility*

Less than $21,870Less than $29,580Less than $37,290Less than $45,000Less than $52,710Less than $60,420Less than $68,130Less than $75,840Greater than $75,841I did not have a parent or guardian present when completing this application, so I am sending the TRIO SSS Income Verification form to my parent/guardian: https://botform.compansol.com/210824754946867
For FAFSA purposes, are you designated as Independent Student financial aid status at BGSU?*

NoYes
Please check all Independent Student financial aid statuses that apply*

At least 24 years oldA ParentA VeteranOrphan/Ward of CourtHomelessAged out of foster care
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 Bowling Green State University’s TRIO Student Support Services to have access to my official records in order to complete my application. (Your application will not be complete without signatures and dates.)

Please sign, date and return this form. If you are considered a dependent, as defined in the FAFSA, you must have your parent/guardian sign and date this form. Electronic signatures will not be accepted. (COVID-19: Electronic signatures will be accepted.)
Print student name*

First NameLast Name
Student Signature*

Clear
Today's Date*

MonthDayYear
mm-dd-yyyy
Print parent or guardian name

First NameLast Name
Parent or Guardian Signature

Clear
Today's Date

MonthDayYear
mm-dd-yyyy
Parent/Guardian Email
example@example.com