Paris Junior College-SSS-Application Form

TRIO Student Support Services Application
TRIO Student Support Services at Paris Junior College provides eligible students with FREE academic advising; financial aid information; financial literacy awareness; career planning; tutorial assistance; and additional support to assist participants in achieving their academic goals. All activities are designed to assist eligible students with persisting in college from year to year; remaining in good academic standing each semester; graduating from PJC with a certificate and/or associates degree; and transferring to a four-year university. Students selected to be in the TRIO Student Support Services program must meet certain criteria set forth by the U.S. Department of Education.
PJC Student ID*
Name*

First NameMiddle Initial Last Name
Preferred Name (if different from first name)
How did you hear about the TRIO Student Support Services program at Paris Junior College?
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Do you live on campus?*

YesNo
Cell Phone Number*
(999)999-9999
Please indicate if TRIO SSS staff can text you regarding your application status and any future notifications. Standard message and data rates may apply.*

YesNo
PJC Email Address*
example@example.com
Personal Email Address*
example@example.com
Date of Birth*

MonthDayYear
mm-dd-yyyy
Gender*

MaleFemale
What is your race and/or ethnicity? (check all that apply)*

American Indian or Alaskan NativeAsianBlack or African-AmericanHispanic or Latino of any raceWhiteNative Hawaiian or Pacific IslanderOther
Are you a U.S. Citizen or Permanent Resident?*

YesNo
Please provide your USCIS#*
At any time since you turned age 13, were both your parents deceased, were you in foster care, or were you a dependent or ward of the court?*

YesNo
Military Connection (Check any that apply)*

Not ApplicableVeteranSpouse of Active Duty MilitaryActive Duty MilitaryChild of Activity Duty MilitaryChild of a Veteran
Did either parent or guardian complete a 4-year college degree (bachelor's degree or higher)?*

MotherFatherBothNeither
What year did you graduate high school or get your GED?*
YEAR
What is your current enrollment classification at Paris Junior College?*

Incoming First Year/FreshmanSophomoreIncoming TransferContinuing Student at PJC
When was your first semester at Paris Junior College?*
Month, Year
What is your major/program of study?*
What is your current enrollment status?*

Part-Time (less than 12 hours)Full-Time (12 hours or more)
What is your current educational goal?*

Earn a 1-year certificate at Paris Junior CollegeEarn a 2-year certificate at Paris Junior CollegeGraduate from PJC with an associate’s degree onlyGraduate from PJC with an associate’s degree and transfer to a four-year universityUndecidedOther
Briefly describe your career plans*
Please select your financial aid student type*

Dependent StudentIndependent Student (are married, have a child or other dependents, are in active duty or a veteran, are aged 24 and above, were in foster care/ward of the court/or an emancipated minor)
Income Statement - On your most recent tax return, what was you family's TAXABLE income? On the IRS Form 1040, this amount can be found on line 15. If you did not file a tax return, enter "0". *Please note that TAXABLE income is usually much lower than adjusted gross income because it accounts for deductions and tax breaks, reducing the portion of earnings subject to federal tax*
Your Household's Annual TAXABLE income
Students may need to meet financial eligibility criteria to be admitted to the TRIO SSS program. Please provide an email address and phone number for your parent/guardian. They will receive notification that you have applied to the TRIO Student Support Services program at Paris Junior College and will be asked to complete an income verification form so that we can review your eligibly. This form must be completed by a parent/guardian to complete your application.
Parent/Guardian First and Last Name*

First NameLast Name
Parent/Guardian Email Address*
example@example.com
Parent/Guardian Phone Number*
(999)999-9999
Number of Family Members in Your Household*
Includes yourself, your spouse, your children, and any other individual who is receiving more than half of their support from you.
Number of family members living in household last year?*

12345678+
Do you have a documented disability?*

Yes - on file with Paris Junior College ADA officeYes - not on file with Paris Junior College ADA officeNo
What services are you interested in receiving through TRIO SSS? (select all that apply)*

Academic and Career AdvisingFinancial Aid Assistance/InformationTutoringTransfer AssistanceStudy Skills/Time ManagementCultural EventsCareer ExplorationFinancial and Economic Literacy/BudgetingProfessional and Peer MentoringOther
Please indicate if you were in a TRIO program previously (select all that apply)*

Educational Opportunity CentersStudent Support ServicesEducational Talent SearchUpward BoundUpward Bound Math-ScienceNone of the above
TRIO Student Support Services (SSS) at Paris Junior College is 100% federally funded by the U.S. Department of Education. TRIO SSS serves 140 participants annually who are from low-income backgrounds, first-generation college students and/or participants with disabling conditions, with a budget of $261,888. Paris Junior College prohibits discrimination, including harassment, against any student on the basis of sex or gender, race, color, national origin, disability, religion, age, or any other basis prohibited by law. A lack of English language skills will not be a barrier to admission and participation in the career and technical education programs of PJC.
Participant Contract Agreement

If I am accepted into the TRIO Student Support Services (SSS) program at Paris Junior College, I agree to the following terms and expectations to remain in good standing with the program:

Participant Responsibilities:
1. Active Participation – I will actively engage in at least two (2) TRIO SSS activities (in-person or virtually) per semester.
2. Meetings – I will meet with my TRIO SSS advisor at least two (2) times per semester to discuss my academic progress and goals.
3. Academic Commitment – I will make a strong effort to maintain good academic standing and seek assistance when needed.
4. Communication – I will check my DragonMail email and TRIO SSS communications regularly and respond when necessary.
5. Program Compliance – I understand that failure to meet participation requirements may result in dismissal from the TRIO SSS program.
By signing below, I acknowledge that I have read and understand the expectations of the TRIO SSS program and agree to fulfill my responsibilities as a participant, if selected.
Is English your first language?*

YesNo
What is your native language?*
Did either parent complete a 4-year degree from a college or university?*

MotherFatherBothNeither
Are you a high school graduate?*

YesNoGED Certificate
What high school did you attend?*
What year did you graduate high school?*
From what state did you obtain your GED?*
What year did you receive your GED?*
Which Paris Junior College degree or certificate are you planning to pursue?*

Associate of Arts (AA) ProgramAssociate of Science (AS) ProgramAssociate of Applied Sciences (AAS) ProgramCertificate Program
What is your major/program of study?*
Do you plan to transfer after graduation from Paris Junior College?*

YesNo
What is your intended transfer university?*

Texas A&M University - CommerceTexas A&M University - TexarkanaUniversity of North Texas - DentonUniversity of Texas - ArlingtonOther
Have you applied for financial aid at Paris Junior College? (select the most recent FAFSA completed)*

Yes - completed FAFSA for 2022-2023 academic yearYes - completed FAFSA for 2023-2024 academic yearNo - I have not completed a FAFSA
What types of financial aid are you receiving? (select all that apply)*

GrantsLoansScholarshipsWork StudyNone
Are you now or have you ever been on financial aid probation or suspension?*

YesNo
Student Personal Statement
For this response, you will have the opportunity to let us know a little more about yourself. Please answer the questions below. Feel free to add any other information that you feel is relevant to our decision in choosing you as a Student Support Services participant. This is a very important part of the application process. In 200 words or less, explain the following:
1. Why do you want to join the TRIO SSS program?
2. What barriers do you feel may hinder your educational success?
3. What kind of job do you want to secure after you graduate from Paris Junior College and why?
4. List three personal goals you hope to complete this year.
These questions do not need to be answered in order, but please make sure to address each one in your statement below.*
How did you hear about TRIO Student Support Services? (select all that apply)*

Blackboard AnnouncementPoster/FlyerClassroom PresentationProfessor/Faculty/StaffReferred by TRIO SSS ParticipantReferred by Financial Aid OfficeReferred by Advising & Counseling OfficeReferred by Disability OfficeParis Junior College WebsiteOther
Release of Information
I declare under penalty of perjury that the information on this form is true to the best of my knowledge.

Pursuant to 20 USA 1231a of the U.S. Department of Education, TRIO SSS at PJC is authorized to access information deemed necessary to assist me in achieving my educational goals or in meeting the reported requirements of the U.S. Department of Education, to record pertinent facts regarding my eligibility in the program, services rendered, and postsecondary education. This information is protected by the Privacy Act, kept confidential and not to be seen unless specifically authorized. A copy of this statement shall serve as such authorization. I authorize TRIO SSS personnel to conduct and communicate information pertaining to my educational outcomes and to fulfill program reporting requirements as they relate to the TRIO SSS program using phone, email, text messaging or other digital mediums. I authorize use of my photograph in TRIO SSS publications and media releases to include my photograph appearing on social media platforms to demonstrate implementation of grant objectives. I authorize TRIO SSS to obtain any records from the PJC Financial Aid Office that may pertain to my participation in the TRIO SSS program.

I will contact Disability Services independently if I would like to participate in TRIO SSS activities and require accommodations. I understand that submission of this application does not guarantee acceptance in the TRIO SSS program.
Type Name:*

First NameLast Name
Today's Date:*

MonthDayYear
mm-dd-yyyy
Signature*

Clear

TRIO Student Support Services Application

Student Personal Statement

Release of Information