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.

Income Verification
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
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
Student Signature*

Clear
Date*

MonthDayYear
Date
Parent Signature*

Clear
Date*

MonthDayYear
Date

Participant Contract
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 your SSS advisor by last name, (A-L Kinzie) (M-Z Corwin)

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