McLennan Community College-SSS-Application Form

2024-2025 TRIO SSS Participation Application
All information provided will remain confidential and be used for TRIO SSS program purposes only.

Applicants have the option to opt out of signing this application electronically and can request a paper application to complete. To request a paper application, please email triosss@mclennan.edu or visit the TRIO SSS office at MCC (SS Building, Room 304).

Only fully completed applications with the corresponding financial discloser will be considered.
Name (First, Middle, Last):*

First NameMiddle NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth:*

MonthDayYear
mm-dd-yyyy
Student Email:*
example@example.com
Cell Phone:*
(999)999-9999
Home Phone:*
(999)999-9999
Gender:*

MaleFemaleNon-binaryOther
Preferred Pronouns:*

He/him/hisShe/her/hersThey/them/theirsOther
What race/ethnicity do you identify with? (Please check all that best describe you.)*

American Indian or Alaskan NativeAfrican American or Native AfricanLatino or HispanicNative Hawaiian or Pacific IslanderAsian American or AsianCaucasian (white)Middle EasternOther
Are you Hispanic/Latino?*

YesNo
What ethnicity do you identify with? (Please check all that best describe you.)*

American Indian/Alaskan NativeAsianBlack or African AmericanWhiteNative Hawaiian or Pacific Islander
MCC ID:*
Major/Academic Program:*
Class Level:*

Freshman (1st year, never attended)Freshman (1-29 hours)Sophomore (30+ hours)
How did you hear about TRIO SSS?*
Previous Educational Experience
High school attended:
Year Graduated (if applicable):
GED completed:*

YesNo
If yes, year completed:*
Attended college/university previously (including dual credit):*

YesNo
If yes, please list school(s) attended:*
Participation in Other Support Programs
Please indicate which educational programs you have previously participated in:*

Talent SearchUpward BoundEOCGear Up AVIDMCC First Generation Scholars ProgramTRIO SSS (at another college/university)N/A
Academic Needs & Educational Motivation

Respond “yes,” or “no” to the following statements:
I am unsure of what I want to major in or do for a career.*

YesNo
I feel unprepared academically for college level coursework.*

YesNo
I have trouble making social connections.*

YesNo
The last time I was in school was five (5) or more years ago.*

YesNo
I want to transfer to a university, and need help in knowing how to do this.*

YesNo
My community supports my decision to attend college at this time.*

YesNo
I have been in foster care, a court appointed guardianship, or experienced homelessness.*

YesNo
I have been in foster care or a court appointed guardianship.*

YesNo
I have experienced, or am currently experiencing, homelessness.*

YesNo
Answer the following questions in complete sentences. Applications without responses will not be reviewed.
What do you hope to gain from your college experience?*
What situations have you faced (in high school, college, or personally) that might prevent you from accomplishing your goals?*
How do you see TRIO SSS partnering with you to help you accomplish these goals? (To learn more about the services/resources of TRIO Student Support Services, visit www.mclennan.edu/student-support-services/.)*
Eligibility

(Due to funding restrictions, international and DACA students are not eligible for the TRIO SSS program.)
I am a*

US CitizenPermanent Resident
Alien Registration #: A*
Do you currently have an Associates or Bachelors degree?*

YesNo
Has your mother graduated with a 4-year degree?*

YesNo
Has your father graduated with a 4-year degree?*

YesNo
Verification of Income
When you completed the 2024-2025 FAFSA, which of the following were you? (Complete the corresponding form below.)*

Dependent Student – claimed by parent(s) or other person(s)Independent Student – over age 24, or if any of the following are true: married, a veteran or active military, have children who receive more than half of their support from you, an orphan or ward/dependent of the court
Certification, Signature, & Date
I certify that all of the information I have provided is correct and true to the best of my knowledge.

The parties agree that this application may be electronically signed. The parties agree that the electronic signatures appearing on this application are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.

I understand that if I wish to receive a copy of this application, I can print it on the Review & Submit page that follows. You may also request a copy of your application by emailing triosss@mclennan.edu.
Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Dependent Student Income Verification Form

Please have a parent or guardian complete this form.

Dependent Student - Claimed by parent(s) or other person(s) on federal income tax filed.

Parents Educational Attainment & Income Form
Student’s Name:*

First NameLast Name
Student’s MCC ID:*
Parent/Guardian Name:*

First NameLast Name
Has student’s mother received a 4-year degree from a college/university?*

YesNo
Has student’s father received a 4-year degree from a college/university?*

YesNo
Number of people living in parent’s household (claimed on taxes – should be at least 2)?*
What is parent’s most recent taxable income* (not adjusted income level) filed with the IRS?*
Please write in a dollar amount (do not put a year taxes were filed)
If you filed Form 1040, your taxable income is documented on line 15.

All of the information on this form is true and complete to the best of my knowledge.
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Independent Student Income Verification Form

Independent Student - considered independent if one of the below:

· over age 24

· married

· a veteran or active military,

· have children who receive more than half of their support from you

· an orphan or ward/dependent of the cour
Student’s Name:*

First NameLast Name
Student ID:*
Number of people living in your household (claimed on taxes – should be at least 1)?*
What is your most recent taxable income* (not adjusted income) filed with the IRS*
Please write in a dollar amount (do not put a year taxes were filed).
*If you filed Form 1040, your taxable income is documented on line 15.

All of the information on this form is true and complete to the best of my knowledge.
Student’s Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
McLennan’s TRIO SSS Project is 100% funded by the U.S. Department of Education with an annual budget of $398,502 to serve 240 participants. All applications are accepted and weighed according to the MCC policy of providing educational opportunities without regard to race, color, age, national origin, religion, sex, disability or sexual orientation.

2024-2025 TRIO SSS Participation Application