265275-Shasta College-SSS-2022 Application Form-Ian

  • TRIO Student Support Services
    Program Application

  • Application for Semester
  • Current Year
    • Demographic Information  
    • Date of Birth *
       - -
    • Sex*
    • i. Preferred Gender Pronouns
    • Gender Pronouns (check all that apply)
    • j. Are you Hispanic or Latino?*
    • How do you describe your racial/ethnic background? (Check all that apply)*
    • What is your citizenship status?*
    • l. Are you a U.S. Citizen or Permanent Resident?*
    • Program Participation  
    • Are you registered with the Partners in Access to College Education (PACE) program for students with disabilities?*
    • What other Shasta College programs do you participate in?
    • b. Have you ever been enrolled in a TRIO program?
    • If so, which one(s)?
    • Educational Information  
    • a. Are you still in high school?*

    • Thank you for your interest in TRIO Student Support Services. Unfortunately, you do not meet federal eligibility guidelines and are not a candidate to receive TRIO services. If you have any questions, please give us a call at 530.242.7690.

    • b. Have you received your high school diploma or GED?*
    • Are you currently enrolled full-time at Shasta College? (Full-time is 12 units or more, 9 units if in the Shasta College PACE Program)*

    • Thank you for your interest in TRIO Student Support Services. Unfortunately, you do not meet federal eligibility guidelines and are not a candidate to receive TRIO services. If you have any questions, please give us a call at 530.242.7690.

    • How many college credits have you completed as of today?*
    • e. How many credits are you enrolled in this semester?*
    • Have you previously been awarded a degree or certificate?

    • Thank you for your interest in TRIO Student Support Services. Unfortunately, you do not meet federal eligibility guidelines and are not a candidate to receive TRIO services. If you have any questions, please give us a call at 530.242.7690.

    • If applicable, what is your college GPA?

    • Thank you for your interest in TRIO Student Support Services. Unfortunately, you do not meet federal eligibility guidelines and are not a candidate to receive TRIO services. If you have any questions, please give us a call at 530.242.7690.

    • f. If not currently enrolled full-time, do you plan on enrolling full-time next semester? (Full-time is 12 units or more, 9 units if in the Shasta College PACE program)*
    • What year do you plan to graduate from Shasta College?
    • Do you plan to transfer to a four-year college or university?*

    • Thank you for your interest in TRIO Student Support Services. Unfortunately, you do not meet federal eligibility guidelines and are not a candidate to receive TRIO services. If you have any questions, please give us a call at 530.242.7690.

    • Please indicate the highest level of education completed by your natural or adoptive* parents (Please do not include stepparent or guardian education levels for this application)

    • *Please do not include stepparent or guardian education levels for this application

    • Financial Aid Status and Eligibility Information 

    • NOTE: If you, the student, are less than 24 years old and are considered a DEPENDENT student, your parent/legal guardian MUST also read and sign this application below.

    • Did you submit your Free Application for Federal Student Aid (FAFSA) or CA Dream Act Application (CADAA) for the current academic year?*
    • Are you a Veteran or a dependent using Veteran educational benefits?*

    • Please answer the following questions to determine your dependency status

    • Were you age 24 or older on December 31st of last calendar year?*
    • Are you married? (Answer yes if separated, but not divorced)*
    • Do you have legal dependents (other than a spouse) who receive more than half their support from you?*
    • Are you currently serving on active duty (for other than training purposes) in the U.S. Armed Forces?*
    • Are you, or prior to age 18, were you in foster care or a ward of the court?*

    • If you answered “yes” to any of the questions above, you are considered a INDEPENDENT student for financial aid reasons. You must provide YOUR taxable income below.

      If you answered “no” to ALL of the questions above, you are considered a DEPENDENT student for financial aid reasons. You must provide the taxable income of your natural or adoptive parents below.

    • DEPENDENT STUDENTS

    • Clear
    • Clear

    • *Parent Signature is required for students who are under 24 years old and/or have been determined to be dependent for financial aid reasons

    • INDEPENDENT STUDENTS

    • Clear
    • Release Statement and Agreement  

    • Please read carefully then sign and date where indicated: Privacy Act Information

      In accordance with the Privacy Act of 1974 (Public Law No. 93-579, 5 U.S.C. 552a), you are hereby notified that the Department of Education is authorized to collect information to implement the Student Support Services program under the Title IV of the Higher Education Act of 1965, as amended (Pub. Law 102-325, Sec. 402D). In accordance with this authority, the Department receives and maintains personal information on participants in the Student Support Services program. The principle purpose for collecting this information is to administer the program, including tracking and evaluating participant progress. The information that is collected on this form will be retained in the program files and may be released to other Department officials in the performance of their official duties.

      • By signing this application, I certify that all information provided above is true and accurate to the best of my knowledge.
      • I understand that all information on this application, as well as that released from the school, will be held in strict confidence by the TRIO Student Support Services program staff.
      • I authorize the release of academic records (e.g. copies of school transcripts, test scores) to the Shasta College TRIO Student Support Services program in order to assess need/eligibility for program services, discern academic progress, evaluate the effectiveness of program activities, and fulfill program reporting requirements.
      • I consent to the disclosure of any personally identifiable information as defined by FERPA of my education records to the Shasta College TRIO Student Support Services program staff for the purpose of confirmation of the student’s postsecondary enrollment status as reported on the National Student Clearinghouse Student Tracker. This authorization will remain in effect for six years following admission into the TRIO SSS program.
      • I authorize the release and exchange of student financial aid information from colleges and federal government to the TRIO Student Support Services program.
      • I authorize the TRIO Student Support Services program to share and discuss information with school personnel in support of my student’s academic success.
      • I also give permission for the TRIO Student Support Services program to take photographs for identification purposes and during activities, and grant permission to use the student’s name, comments, and/or photos/videos for educational and/or promotional purposes.
      • I understand that this authorization will remain in effect while the student is enrolled in the Shasta College TRIO Student Support Services program or until written notice is provided to revoke the authorization.
    • Clear
    • Date
       - -

    • **Incomplete or unsigned applications will be returned for completion before being considered for enrollment**

    • Submit  
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