Grayson County Junior College District-SSS-Application Form

Student Support Services Program Application

TRIO Student Support Services at Grayson College provides academic development services including academic tutoring, advice and assistance in postsecondary course selection, information on financial aid and scholarships, assistance in completing financial aid applications, education and counseling services designed to improve financial and economic literacy, and assistance with applying for admission to 4-year programs or institutions. All programs and services are designed to assist participants with persistence, maintaining good academic standing, and graduating from Grayson College.

Participants selected for the SSS program must meet the U.S. Department of Education criteria. The Grayson College Student Support Services Program is funded from 2020-2025 by the U.S. Department of Education.
- Name*
  
  First NameMiddle InitialLast Name
- Student ID*
- DOB*
  
  MonthDayYear
  mm-dd-yyyy
- Gender*
  
  MaleFemale
- Phone Number*
  (999)999-9999
- Please indicate if TRIO SSS staff can text you regarding your application status or send upcoming event reminders:*
  
  YesNo
- Student Email*
  example@vikings.grayson.edu
- Personal Email*
  example@example.com
- Mailing Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Who is your emergency contact? (First Name, Last Name)*
- Relationship to Emergency Contact
  
  Parent/GuardianSpouseFriendSibling
- Phone Number*
  (999)999-9999
- Highest Level of Education You Have Completed*
  
  High School/GEDAssociate's Degree/CertificateBachelor's DegreeGraduate Degree
- When was your first semester at Grayson College?*
  Month, Year
- Is your ethnicity Hispanic or Latino?*
  
  YesNo
- Race*
  
  American Indian/Alaskan NativeAsianBlack or African AmericanWhiteNative Hawaiian or Other Pacific IslanderHispanic or latinoMore than one race reported
- Are you a U.S. Citizen?*
  
  YesNoU.S. Permanent Resident
- Permanent Resident Number*
- Do you have a documented disability?*
  
  YesNo
- Are you registered with the Disability Services at Grayson College?*
  
  YesNo
- How did you hear about SSS?*
- How did you hear about SSS?*
  
  Staff/FacultyPresentationWord of MouthAdvertisementOther
- My t-shirt size is:*
  
  SMLXL2XL
- At anytime since you turned age 13, were both parents deceased, were you in foster care, or were you a dependent or ward of the court?
  
  YesNo
- Eligibilty-Potential First Generation College Student Status
- At anytime since you turned age 13, were both parents deceased, were you in foster care, or were you a dependent or ward of the court?
- Did either of your parents or legal guardian who have provided your support until 18, earn a 4 year degree?
  
  MomDadLegal guardianNeither
- Has your mother graduated from college with a 4-year degree?
  
  YesNo
- Has your father graduated from college with a 4-year degree?
  
  YesNo
- Before the age of 18, with whom did you reside?
  
  MotherFatherOther
- Term*
  
  SpringSummerFall
- Today's Date*
  
  MonthDayYear
  mm-dd-yyyy
- Age*
- Hours completed?*
- Intended Graduation Date*
  
  MonthDayYear
  mm-dd-yyyy
- Are you planning to transfer from Grayson to a 4-year institution?*
  
  YesNoUnsure
- Are you a veteran?*
  
  YesNo
- Have you completed the FAFSA Application?*
  
  YesNo
- Are you receiving Financial Aid?*
  
  YesNo
- Are you currently on financial aid warning or suspension?*
  
  YesNo
- At anytime since you turned age 13, were both your parents deceased, were you in foster care, or were you a dependent or ward of the court?*
  
  YesNo
- Did either of your parents earn a 4-year degree?*
  
  MomDadLegal GuardianNeither
- Are you a/an?*
  
  Dependent StudentIndependent Student (married, have a child or other dependents, active duty or a veteran, age 24 or above, foster care alumni, ward of the court, or emancipated minor)
- Size of family unit*
  
  12345678
- My total household income is at or below:*
  
  $23,475$31,725$39,975$48,225$56,475$64,725$72,975$81,225
- Grayson College TRIO SSS will retrieve information you have on file with the Grayson College Financial Office. You may be contacted to verify income eligibility.
- Current Classification*
  
  Incoming- Freshman (0 Credits)Freshman (1-30 Credits)Sophomore (30+ Credits)
- Select your Degree*
  
  CertificateAASASTransient Student
- Are you looking to transfer to a 4 year college?
  
  YesNoUnsure
- Current Major/Program of Study:*
- Cumulative GPA:*
- What is your current enrollment status?*
  
  Part-time (less than 12 hours)Full-time (12 hours or more)
- Are you on academic probation or suspension?:*
  
  YesNo
- Are you a veteran?
  
  YesNo
- What are your academic goals?*
- What are your academic concerns?*
- Please select all services you are interested in receiving:*
  
  Academic Guidance (assistance with staying on track to graduate on time)Academic Tutoring and Development (assistance with study strategies, study concepts, time management, navigating campus resources, and organization)Tutoring (access to one-on-one tutoring)Career Guidance (assistance with major and career exploration)Financial Aid Information (assistance completing the FAFSA and scholarship applications)Transfer Assistance (University admissions policy information, selection, and application process)Financial Literacy (assisting with money management, loan forgiveness, paying for college budgeting, etc)Other
- Please select all services you are interested in receiving:*
  
  Academic Guidance (assistance with staying on track to graduate on time)Academic Tutoring and Development (assistance with study strategies, study concepts, time management, navigating campus resources, and organization)Tutoring (access to one-on-one tutoring)Career Guidance (assistance with major and career exploration)Financial Aid Information (assistance completing the FAFSA and scholarship applications)Transfer Assistance (University admissions policy information, selection, and application process)Financial Literacy (assisting with money management, loan forgiveness, paying for college budgeting, etc)Other
- Other*
- Briefly describe your career plans:*
- Academic Needs*
  
  Academic proficient testsFailing gradesHigh School equivalencyLack of academic preparedness for college level course workLimited English proficiencyLow admission test scoresLow college gradesNeed for academic support to raise gradesOut of academic pipeline for 5 or more yearsOther
- I certify that all of the above information is correct. I release the following information to Grayson College TRIO Student Support Services: High School transcripts, assessment scores, grade reports, financial aid records and any other information from my records that pertains to my enrollment. I also authorize Grayson College TRIO Student Support Services to release information from my records for the purpose of providing services that I might need.
- Student's Signature*
  
  Clear
- Date*
  
  MonthDayYear
  mm-dd-yyyy
- TRiO Support Services five-year grant program funded by the U.S Department of Education
- TRIO Student Support Services Income Verification Form
- Name*
  
  First NameLast Name
- Grayson Email Address*
  example@example.com
- >INDEPENDENT STUDENTS
  
  (24+ years old; have been married/divorced; have children that you financially support, is active duty or a veteran, foster care alumni, ward of the court, or an emancipated minor)
  
  >DEPENDENT STUDENTS
  
  (Under 24 yrs. Old; are not married; no children of your own that you are financially supporting; not active duty/veteran; have never been in foster care or a ward of the court; not an emancipated minor)
  
  MUST PROVIDE PARENT/GUARDIAN SIGNATURE
- Select One:*
  
  IndependentDependent
- >INDEPENDENT STUDENTS
  
  (24+ years old; have been married/divorced; have children that you financially support, is active duty or a veteran, foster care alumni, ward of the court, or an emancipated minor)
- I certify that there are ______ (number) of people in my household*
- I certify that my household's taxable income is below / above the amount that corresponds with the size of family unit in the chart above.*
  
  BelowAbove
- I certify that my household's taxable income is _____(enter amount)
- Name:*
  
  First NameLast Name
- Date*
  
  MonthDayYear
  Date
- Student Signature:*
  
  Clear
- Date*
  
  MonthDayYear
  Date
- >DEPENDENT STUDENTS
  
  (Under 24 yrs. Old; are not married; no children of your own that you are financially supporting; not active duty/veteran; have never been in foster care or a ward of the court; not an emancipated minor)
  
  MUST PROVIDE PARENT/GUARDIAN SIGNATURE.
- Parent Name:*
  
  First NameLast Name
- Student Name:*
  
  First NameLast Name
- I certify that there are ______ (number) of people in our household*
- I certify that my household's taxable income is below / above the amount that corresponds with the size of family unit in the chart above.*
  
  BelowAbove
- I certify that my household's taxable income is _____(enter amount)
- Student Signature*
  
  Clear
- Date*
  
  MonthDayYear
  Date
- Parent Signature*
  
  Clear
- Date*
  
  MonthDayYear
  Date
- Please read and initial the following statements and requirements for becoming a member of TRIO Student Support Services at Grayson College.
  
  If accepted to SSS, I will make contact with my SSS advisor at least 2 times per semester to utilize services, attend workshops, trips, or give progress updates.
  
  You will be contacted by the TRIO SSS staff for program engagement
  
  If accepted to SSS, I will complete at least one Financial Literacy workshop each semester.
  
  These online workshops can be completed at www.financialliteracy101.org. You will create an account with your SSS Advisor once accepted into the program.
  
  If accepted to SSS, I will attend at least one in-person workshop or group university trip/cultural trip each semester.
  
  In-person workshops and group trips will be announced each semester via text, email, and canvas announcements
  
  If accepted to SSS, while in the office or on an SSS organized trip, I agree to behave in a manner consistent with the mission of both Grayson College and the Student Support Services program.
  
  -The Code of Conduct lists the following behaviors as unacceptable:
  
  Using foul language
  
  Misconduct including disturbing others and/or disrespecting others
  
  Physical/verbal abuse or mistreatment of any person
  
  Theft, vandalism, defacement, or damage to property
  
  Disorderly conduct
  
  Drinking illegally, or using illegal substances
  
  If accepted to SSS, as an active member I am eligible to apply for the SSS Scholarship by maintaining a 2.5 GPA, completing Financial Literacy 101, and submitting the scholarship application and supporting documents by the deadlines set by SSS staff.
  
  If accepted to SSS, I authorize SSS to take photographs of me to be copyrighted, published, exhibited, or included on the official Grayson College website or newspaper. I further release Grayson College from any and all claims for damages for libel, slander, invasion of the right of privacy or any other claim based in the use of said materials. If I would like to be excluded from any photos taken, I will politely let the SSS staff know.
- Student Signature*
  
  Clear
- Date*
  
  MonthDayYear
  mm-dd-yyyy
- The TRIO Student Support Services staff will review the information provided, and reach out via email and text to give updates on application status and next steps.

TRIO Student Support Services Income Verification Form