Caldwell Community College & Technical Inst-SSS-Application Form

Demographics
Race/Ethnicity (Check all that apply)*

Hispanic/LatinoNative American/Alaskan NativeAsianBlack or African AmericanNative Hawaiian/Pacific IslanderWhite

First Generation Status
Before you turned 18, did either parent or guardian with whom you reside/resided have a bachelor’s degree?
Mother/Female Guardian:*

YesNo
Father/Male Guardian:*

YesNo

Income Verification
Please complete only 1 of the 3 sections below. Check the appropriate box to indicate your chosen method of income verification.

If you are an independent student as defined by the Financial Aid office, please use your own income information.

If you are a dependent student as defined by the Financial Aid office, please use your parent/guardian’s income information.
Option 1: Income Tax Return Included

I am including my/my parent or guardian’s income tax return for last year with this application.
Tax Return

Cancelof
Option 2: Financial Aid Application Included

I am including my financial aid application with this application
Financial Aid Application

Cancelof
Option 3: Statement including Family Taxable Income and Family Size

I/my parent or guardian filed an income tax return last year.
The number of individuals currently living in my household and/or claimed as dependents (including myself) is
My/my parent or guardian’s taxable income for last year was
(Form 1040 line 43 or Form 1040A line 27)
Please note that taxable income is different from gross or net income.

Disability Status
Are you registered with CCCTI Disability Services) Office?*

YesNo
Do you believe you may have an undiagnosed mental, physical, or learning disability or do you identify yourself as a student with a disability?*

YesNo
If yes, please explain.*

TRIO History
Have you participated in any of the following TRIO programs?*

Upward BoundVeterans Upward BoundTalent Search StudentSupport ServicesNone
If yes, at which school?*

First-Generation Personal Statement
Please write a short statement about your educational goals and career aspirations. In your statement, please also tell us about the services or support you may need in order to achieve academic success and/or graduate.*

TRIO/Student Support Services Program Application