Rock Valley College-SSS-Application Form

TRIO Student Support Services Application

The Student Support Services (SSS) Project of Rock Valley College provides eligible students with FREE academic advising; financial aid information; financial literacy awareness; career planning; designated computer lab access (printing services); and tutorial assistance to assist participants in achieving their academic goals. All SSS activities are designed to assist eligible students persistence in college from year to year; remain in good academic standing each semester; and graduate from RVC. Students selected to be SSS Participants must meet certain criteria set forth by the Department of Education. RVC SSS is a 100% federally-funded TRIO program ($261,888 annually for 5 years) under the U.S. Department of Education.

Rock Valley College
Division of Student Services
TRIO Student Support Services
3301 N. Mulford Road, Rockford, IL 61114
RockValleyCollege.edu/TRIO (http://rockvalleycollege.edu/TRIO)
For assistance with the application please call (815) 921-4280

FINANCIAL AID AND DEPENDENCY STATUS
Have you completed a FAFSA?*

YesNoUnsure
Are you receiving Financial Aid this Semester?*

YesNoUnsure

DEPENDENT STUDENTS
NOTE: Taxable Income can be found on the federal income tax return, IRS Form 1040, line 10
Please bring a copy of your 2022 tax return, a transcript of the return, or a Verification of Non-filing letter from the IRS to the TRIO department on the second floor of the Student Center or email to RVC-TRIO@rockvalleycollege.edu (mailto:RVC-TRIO@rockvalleycollege.edu)
Name of Parent/Legal Guardian*

First NameLast Name
Parent Phone Number
(999)999-9999
Parent Email
example@example.com
Did either of your parents earn a 4-year degree from a college/university?*

YesNoUnsure
Which parent?*

MotherFatherBoth
Were you raised by this or both of these parents?*

YesNo
Number of people living in parent/legal guardian’s household*
What was parent/legal guardian’s 2022 TAXABLE* INCOME? (This is NOT adjusted gross income and is listed on the 2nd page of most tax forms)*

INDEPENDENT STUDENTS
NOTE: Taxable Income can be found on the federal income tax return, IRS Form 1040, line 10
Please bring a copy of your 2022 tax return, a transcript of the return, or a Verification of Non-filing letter from the IRS to the TRIO department on the second floor of the Student Center or email to RVC-TRIO@rockvalleycollege.edu (mailto:RVC-TRIO@rockvalleycollege.edu)
Did either of your parents earn a 4-year degree from a college/university?*

YesNoUnsure
Which parent?*

MotherFatherBoth
Were you raised by this or both of these parents?*

YesNo
Number of people living in student’s household*
What was the student's 2022 TAXABLE* INCOME? (This is NOT adjusted gross income and is listed on the 2nd page of most tax forms)*

STATEMENT OF AGREEMENT AND CONSENT
I give RVC TRIO SSS, its representatives and employees, to take photographs/videos of me and my property in connection with all TRIO SSS related activities. I authorize TRIO SSS, its assignees, and transferees to copyright use and publish the same in print and/or electronic media. I agree that TRIO SSS may use such photographs of me with or without my name for lawful purposes, including, but not limited to, publicity, advertising, social media, and web content in connection with TRIO SSS.*

YesNo
I give the RVC TRIO SSS Program staff permission to obtain any academic or personal information that is necessary for providing assistance to me, evaluating the effectiveness of the program, and fulfilling federal and college reporting requirements. This information may be obtained for college departments/personnel, including, but not limited to: RVC faculty, Services, Dean of Students, Student Life, and peer mentors/tutors.*

YesNo
I certify that the above information contained on this application is true and complete to the best of my knowledge. I understand that this information will be treated as confidential, but will be reported to the U.S. Department of Education as a condition of funding for this federally funded program. Further, I understand that the Rock Valley College TRIO SSS ACHIEVE AND COMPLETE programs will review my transcript and financial aid information to verify eligibility, determine appropriate services, and track academic progress
By signing, I attest that all the information on this application is true.*

Clear