North Central State College-SSS-Application Form

  • Student Support Services Application

    NC STATE COLLEGE TRiO - 419.755.9015 - triosss@ncstatecollege.edu - www.ncstatecollege.edu/student-services/trio
    • APPLICATION INSTRUCTIONS 

    • TRiO Student Support Services is a federally funded program through the U.S. Department of Education that provides additional support and resources to students who apply and are accepted.  Please complete this application in its entirety.  The information you provide is strictly confidential.  Upon receipt of your application, a member of our Trio team will contact you to schedule an appointment.

    • BEFORE RETURNING YOUR APPLICATION TO THE PROGRAM, MAKE SURE YOU HAVE THE FOLLOWING:
    • DEMOGRAPHIC INFORMATION 
    • Date of Birth:
       - -
    • Race/Ethnicity (Check all that apply to you):
    • Are you Hispanic/Latino?
    • Marital Status:
    • Gender:
    • Citizenship:
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    • Do you speak English as a Second Language (ESOL)?
    • ACADEMIC INFORMATION 
    • Student Classification:
    • Highest Level of Education:
    • Educational Goals:
    • Anticipated attendance:
    • Anticipated NCSC Graduation Date:
       - -
    • Are you planning to transfer to a four-year college or university?:
    • Have you previously participated in a TRIO program?
    • PROGRAM ELIGIBILITY 
    • Has either of your parents graduated from a 4-year college or university (Bachelor's Degree)?
    • Do you have a documented physical, mental, or learning disability?
    • If yes, are you registered with NCSC's Office of Specialized Supportive Services?
    • Do you currently have an Associate's or Bachelor's degree?
    • The federal government uses the following criteria to determine INDEPENDENT student status. Please check all that apply to you:

    • If you DID NOT CHECK any of the above, you are considered a DEPENDENT student and must submit your parents or guardians signed Federal Income Tax Return for 2021. Otherwise, you are considered an INDEPENDENT student and must submit your signed Federal Income Tax Return for 2021.

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    • FINANCIAL ELIGIBILITY 

    • TAXABLE INCOME: It is very important you indicate TAXABLE INCOME and not total income or adjusted gross income. The best source for this information is your 2021 Federal Income Tax Return. Taxable income is reported on: line 43 of form 1040; line 27 of 1040A; or line 6 of 1040EZ. (If you do not have a copy of your Federal Income Tax Return, visit http://www.irs.gov/Individuals/Get-Transcript where you can obtain a copy of your Tax Transcript online - NOTE: You will need to create an account on that website)

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    • FAMILY SIZE: If you live with your parents, include them, yourself, siblings, and any other person supported by your parents. If you are independent, include yourself, spouse, children, and any other person supported by you.

    • Who claimed you for income tax purposes for 2021?
    • Financial Aid Status: (check all that apply)
    • Check agencies which provide services to you and/or assistance you receive:
    • How did you learn about TRIO Student Support Services?

    • I certify the information I provided on this application is, to the best of my knowledge, true and accurate. By applying to this program, I authorize TRIO Student Support Services to access information pertinent to my participation from other NCSC departments. Also, I recognize that completing this application does not guarantee my admission to the program.

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    • Date
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    • (Parent signature is NOT needed if the student is independent.)

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    • Date
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    • *TRIO Student Support Services is 100% federally funded at $253,032 through the U.S. Dept. of Ed.

    • Needs Assessment Survey 
    • As a student, I want to: (Check all that apply)
    • Please check any of the following items which describe you:
    • What obstacle(s) would most likely prevent you from completing your academic goals? (Check all that apply)

    • My most important areas which I will need assistance are: (check all that apply)

    • Financial:
    • Academic:
    • Personal Issues:
    • Transfer to a 4-year Institution:
    • Career:
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