San Jose State University-SSS-Application Form

SSS (ASPIRE) Program Application
SSS (ASPIRE) Program, San Jose State University

One Washington Square

San Jose, CA 95192-0127

(408)924-2540 Fax (408)924-2634

Please fill in the following requested information to assist us in determining your eligibility for SSS (ASPIRE) services.
PLEASE NOTE: In order to complete this application, you are going to need the following items:
1. A 500-700 word personal essay answering the following questions:
  1. What are your academic goals, and how can the TRiO SSS program help you accomplish them?
  2. What is your biggest academic need at the moment?
  3. Please share anything else about yourself that will help us to get to know you better
2. A photo of yourself (This photo is only for internal records, and will not be shared publicly)

Section II: Program Eligibility
Are you a U.S. citizen or permanent resident of the United States?*

YesNoOther
Permanent Resident Number (If applicable)
Please check all of the following that you believe apply to you.*

First-GenerationLow-IncomeRegistered Disability
Have either of your parents received a 4-year degree?*

YesNoYes, but outside of the U.S.
First parent's highest level of education*
Second parent's highest level of education*
Before the age of 18 with whom did you regularly reside and receive support from?*

Mother onlyFather onlyBoth
Are you a dependent? If you answer YES to ANY of these questions, then you may be an independent student. If you answer NO to ALL of these questions, then you may be considered a dependent student and may be required to provide your parents' income tax information.

For more information, visit: https://studentaid.gov/apply-for-aid/fafsa/filling-out/dependency

Are you:*

	Yes	No
1. Will you be 24 or older by Jan 1st of the school year for which you are applying for financial aid? For esample, if you plan to start school in August 22 for the 22-23 school year: will you be 24 on 1/1/22
2. Are you married or separated but not divorced?
3. A graduate or professional student (currently enrolled in a program such as M.A., MBA, M.D., J.D., Ph.D., Ed.D., etc?
4. Do you have children who receive more than half of their support from you?
5. Do you have dependents (other than children or a spouse) who live with you and receive more than half of their support from you?
6. Are you currently. serving on ative duty in the U.S. armed forces for purposes other than training?
7. Are you a veteran of the U.S. armed forces?
8. At any time since you turned age 13, were both of your parents deceased, were you in foster care, or were you a ward or dependent of the court?
9. Are you an emancipated minor or are you in a legal guardianship as determined by a court?
10. Are you an unaccompanied youth who is homeless or self-supporting and at risk of being homeless?

Family Income
What is your dependency status?

I am a dependentI am independent
What is the size of your parent's household, including yourself?
Did your parent(s) file a federal income tax return previous year?

YesNo
Reference the taxes that you used for the most recent FAFSA.
If yes, what was their taxable income for the previous year? If no, place a 0 on the line for taxable income.
Line 10 on the IRS form 1040
If you are independent, what is the current size of your household? (including all dependents)
Did you file a tax return for the previous year?

YesNo
If yes, what was your taxable income? If not, put a 0. (Line 10 on the IRS form 1040),
DID NOT FILE A TAX RETURN

In accordance with the eligibility requirements set forth by the U.S. Department of Education, I hereby certify that NO Federal or State tax return was filed with the IRS for the previous year.
I certify that TOTAL INCOME from all sources in the year of...
...was...
$
The reason for not filing was...
Signature of Parent/Guardian (if dependent) or Self (if independent)

Clear
Date

MonthDayYear
Date
Documented Disability
Do you have a documented disability?*

YesNo
Have you registered with SJSU's Accessible Education Center (AEC)?*

YesNo

Section III: Education Information
Did you graduate from High School?*

YesNo
Name of High School*
Year of graduation*
Did you receive your GED (if applicable)?

YesNo
If so, what year did you receive your GED?
What is your class standing at the beginning of this coming fall semester at SJSU?*

First-time FreshmanSophomoreJuniorSeniorTransfer
If you are a Transfer Student
Credits Transferred*
Non-transfer students can add 0
Community College Attended*
Non-transfer students can add N/A
Degree Plans
Major*

Section IV: Additional Information

Please list any college courses you completed while in high school (include grades earned):

	Course	Grade
1
2
3
4

Please mark the programs in which you have participated:*

Talent SearchUpward BoundAVIDGear UpNone of the aboveOther
Are you a participant of EOP at SJSU?*

YesNo
*EOP students are not eligible for ASPIRE services*
Have you applied for financial aid at SJSU?*

YesNo
To the best of your knowledge, check all that you are/will be receiving*

Cal Grant A or BWork StudyPell GrantNone of the above
How did you find out about the ASPIRE Program? *

Essay
In 400-700 words please submit a short essay which answer the following questions:

What are your academic goals, and how will SSS TRiO help you to accomplish them?
What is your biggest academic need at the moment?
Please share anything else about yourself that would get us to know you a little better.
Essay*

0/700
Please upload a picture*

Cancelof

SSS (ASPIRE) Program Student Participation Contract
If accepted into SSS (ASPIRE), I will be eligible for the following benefits…

▪ ASPIRE staff member who services as my academic mentor, advisor, career counselor, and resource consultant

▪ Supplemental Grant Aid

▪ ASPIRE Incentive Program

▪ ASPIRE student computer lab

▪ Mentoring from experienced upperclassmen – ASPIRE staff, student staff, and ASPIRE Student Association

▪ Cultural Activities

If accepted into SSS (ASPIRE), I agree to the following

▪ I agree to attend all enrolled classes and will complete assigned homework.

▪ As a NEW and Continuing participant, I will meet with my ASPIRE Advisor at least 3 times a semester.

▪ To continue being an active participant, I understand that each academic year I will need to renew my program participation.

▪ If I am not an active participant or do not respond to attempt contacts from the SSS staff, I can be removed from the program and will have to reapply.

▪ I agree to participate in at least one study skill/advising workshop, social, or cultural activity during the semester. I will discuss scheduling conflicts with my advisor.

▪ I will review my mid-term progress reports each semester and discuss my grades with my ASPIRE Advisor

▪ I will read/check my email weekly to keep updated and current with ASPIRE activities.

▪ I will be honest and conscientious with the ASPIRE staff and use its services to help me be a successful college student.

▪ Being in the SSS (ASPIRE) program is a privilege and I will be expected to behave in a respectful and professional manner.
Signature:*

Clear
Date: *

MonthDayYear
mm-dd-yyyy

ASPIRE Program Consent to Release
(To be completed by all applicants)

I understand that the ASPIRE Program needs access to my financial, personal and academic information in order to provide the best possible support for me at San Jose State University. Therefore, I agree to release such information to the ASPIRE staff members as long as I am considered an active participant or a student at SJSU. I
further understand that all released material will remain confidential as mandated by FERPA (Federal Family Educational Rights and Privacy Act of 1974). Academic information and disability verification, however, will be shared with faculty, university departments, the Coordinator for Accessible Education Center, and appropriate representatives of the U.S. Department of Education only as necessary.
I also agree to allow my name and/or picture to be printed in any ASPIRE newsletter, publication, web site, or display in recognition of academic success, leadership, or graduation.*

YesNo
By my signature I certify that I am eighteen years old or older, that I have read and understood this Consent to Release and that I am capable of giving such consent and do so voluntarily.
Name:*

First NameLast Name
STUDENT SIGNATURE:*

Clear
Date*

MonthDayYear
mm-dd-yyyy
If under eighteen years of age, parental signature is required.
Parental Signature

Clear
Date

MonthDayYear
mm-dd-yyyy
Release of Information
(To be completed by students with disabilities)

I agree to allow my ASPIRE Advisor to discuss issues related to my academic progress with the Disability Resource Center staff for the purpose of coordinating academic and personal support services as long as I am an active ASPIRE participant.

By my signature I certify that I am eighteen years old or older, that I have read and understood this Consent to Release and that I am capable of giving such consent and do so voluntarily.
Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
If under eighteen years of age, parental signature is required.
Parental Signature

Clear
Date

MonthDayYear
mm-dd-yyyy

SSS (ASPIRE) Program Application

Documented Disability