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

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.

Please answer the following questions to determine your dependency status

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.

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.

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