University Of North Carolina-Greensboro-SSS 1-Application Form

SSS- Classic Program Application
- Student ID #:*
- Date:*
  
  MonthDayYear
  mm-dd-yyyy
- Name:*
  
  First NameLast Name
- Pronouns:*
- Date of Birth:*
  
  MonthDayYear
  mm-dd-yyyy
- UNCG Email: *
  example@example.com
- Cell Phone Number:*
  (999)999-9999
- Home Phone Number:*
  (999)999-9999
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Sex*
  
  MaleFemale
- Race (Check all that apply):*
  
  American Indian/Alaskan NativeBlack or African AmericanHispanicNative Hawaiian/Pacific IslanderAsianWhite
- Ethnicity (Check all that apply):*
  
  American Indian/Alaskan NativeBlack or African AmericanHispanicNative Hawaiian/Pacific IslanderAsianWhite
- Citizenship: Are you a US citizen or permanent resident?*
  
  YesNo
- Marital Status:*
  
  SingleMarriedDivorcedSeparated
- Number of Children:*
- What is the best way to contact you?*
  
  EmailCell PhoneHome PhoneMail
- Emergency Contact
- Name:*
  
  First NameLast Name
- Relationship:*
- Phone Number:*
  (999)999-9999
- Education Completed:*
  
  High School DiplomaGEDAdult High SchoolAssociate’s DegreeBachelor’s Degree or Higher
- High School Diploma Year Completed:*
- GED Year Completed:*
- Other Colleges Attended:*
- Major/Program of Study: *
- Minor/Concentration:*
- Cumulative GPA:*
- Current Classification:*
  
  1st Year2nd Year3rd Year4th Year
- Are you planning on enrolling in 12+ credit hours/semester?*
  
  YesNo
- Have you participated in any of the following TRIO programs?*
  
  Upward BoundUpward Bound Math-ScienceVeterans Upward BoundTalent SearchEducational Opportunity CenterStudent Support ServicesI have not participated in any other TRIO Programs
- If yes, at what school?*
- First-generation college student means:
  1. A student neither of whose natural or adoptive parents have received a baccalaureate degree; OR
  2. A student who, prior to the age of 18, regularly resided with and received support from only one parent who did not receive a baccalaureate degree; OR
  3. An individual who, prior to the age of 18, did not regularly reside with or receive support from a natural or adoptive parent
- Did either biological or adoptive parent with whom you resided prior to you turning 18 have a 4 -year college degree?*
  
  YesNoUnsure
- Have you ever been in foster care at any time, since the age of 13?*
  
  YesNo
- Would you be considered homeless (defined by the McKinney-Vento Homeless Assistance Act)?*
  
  YesNo
- Are you registered with the UNCG Office of Accessibility Resources &Services (OARS)?*
  
  YesNo
- Do you receive accommodations at UNCG?*
  
  YesNo
- Do you believe you have a mental, physical, or learning disability or do youidentify as a student with a disability?*
  
  YesNo
- Documentation of household size and taxable income is required to determine
  eligibility for participation in TRIO programs. All information is kept confidential.
- Please select one:*
  
  I am a Dependent Student (younger than 24, unmarried or emancipated; parent income is reported on the FAFSA)I am an Independent Student (typically age 24 or older, married or emancipated; Parental income is not reported on the FAFSA)
- Total number of persons (include yourself) in your family: *
- Have you filed for financial aid this year?*
  
  YesNo
- Did you receive a Pell Grant?*
  
  YesNo
- How are you paying for your education? (Check all that apply):*
  
  Pell GrantWork-StudyLoanSelfNC WorksEmployerParent/GuardianVA LoanVocational RehabilitationOther
- UNCG
  
  INCOME VERIFICATION FOR TRIO PROGRAMS
- STUDENT INFORMATION:
- Name:*
  
  First NameLast Name
- Student ID:*
- Student Email:*
  example@example.com
- Phone:*
  (999)999-9999
- STUDENT CONSENT:
  
  By my signature below, I, {income_student_name}, authorize and direct the University of North Carolina at Greensboro (UNCG) to:
  - A. Verify my family’s income for the preceding year, using Federal Tax Information (FTI) data from my Free Application for Federal Student Aid (FAFSA), for the purpose of verifying my eligibility to participate in TRIO programs.
  - B. Verify my family’s non-filing status for the preceding year using Federal Tax Information (FTI) data from my Free Application for Federal Student Aid (FAFSA), for the purpose of verifying my eligibility to participate in TRIO programs.
  - C. Produce and release an un-redacted copy of the preceding year’s, Institutional Student Information Record (ISIR) to my attention, for the purpose of verifying my eligibility to participate in TRIO programs.
  To participate in TRIO programs as a “low-income individual,” my family’s taxable income cannot exceed 150 percent of the poverty level amount established by the Census Bureau. In absence of an IRS tax transcript, UNCG will utilize Adjusted Gross Income (AGI) information provided during FAFSA Completion.
  
  I agree that such verification described in options A and B may be provided to TRIO staff employed by UNCG and involved with the supervision and direction of projects funded under the Federal TRIO programs.
  
  I understand that the above records and information:
  1. May include return information disclosed under section 6103(l)(13) of title 26; and
  2. May only be used for the specific purpose outlined in this consent form and no other purposes.
  It is my intent that this consent form be interpreted to the extent permitted by applicable law, including but not limited to the Internal Revenue Code, the Higher Education Act, and the Family Educational Rights and Privacy Act.
- Student Signature*
  
  Clear
- Date*
  
  MonthDayYear
  Date
- Parent/Legal Guardian Signature*
  
  Clear
  (if Student is under 18 years of age)
- Date*
  
  MonthDayYear
  Date
- Please check all that apply to your academic need:*
  
  Low High School GradeLow Admissions ScorePredictive IndicatorsHigh School EquivalencyFailing GradesLimited EnglishNeed Academic SupportLack of educational or career goalsLack of academic preparednessOut of Academic Pipeline for more than 5 years
- I certify that the information provided on this application is correct to the best of my
  knowledge, and I give permission to the TRIO staff to access my academic, financial,
  and disability information to verify my eligibility for TRIO programs. I understand that
  this information will be kept confidential.
  
  I give the TRIO staff permission to discuss my grades, classroom skills/difficulties with my instructors in order for appropriate tutoring/student support to be arranged. This information may be given to TRIO in verbal or written form.
- Student Signature *
  
  Clear
- Date*
  
  MonthDayYear
  mm-dd-yyyy
- Biological or Adoptive Parent Signature (If under 18)*
  
  Clear
- Date*
  
  MonthDayYear
  mm-dd-yyyy

SSS- Classic Program Application

UNCG