Allan Hancock College-SSS-Application Form

4. Are you a U.S. Citizen or Permanent Resident?*

YesNo

Are you an AB 540 or DACA student?

YESNO

5. Have either of your parents receive a bachelor’s degree from a four-year college or university?*

YesNo

6. Do you have any physical or learning disabilities?*

YesNo

If yes, are you registered with the Learning Assistance Program at AHC?*

YesNo

Federal Regulations require the TRIO/SSS Program at AHC to obtain household and income information to determine eligibility for each student applying to participate.

7. Please indicate household size:*

8. Please indicate total family annual TAXABLE INCOME from 2020: Taxable Income is the total AFTER your deductions are taken. This can be found using the IRS form 1040: use line 11b; *

9. What areas best describe your academic need(s)? (Check all that apply)*

10. What is your academic goal at Allan Hancock College?

UndecidedCertificateAssociate DegreeAA degree and/or Transfer

a. What is your Major?

11. Are you a participant in any of the following programs? Check all that apply*

EQUAL OPPORTUNITY

Thank you for your interest in the TRIO/Student Support Services Program at Allan Hancock College. All applicants will be considered without regard to race, color, religion, national origin, sexual orientation, marital status or disability.

DECLARATION

I hereby authorize any school, college or university to release any academic or financial aid information from my files that is requested by the TRIO/SSS Program at AHC.

Signature*

Date*

mm-dd-yyyy

Disclosure Statement

The TRIO/SSS Program at AHC is funded through a Federal TRIO Grant from the U.S. Department of Education.

Annual Funding (2022-2023) is $261,888 (100%) total funds.

CAN-TRIO Application