SSS- STEM Program Application

Emergency Contact

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

Documentation of household size and taxable income is required to determine
eligibility for participation in TRIO programs. All information is kept confidential.

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.

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.