Western Nebraska Community College-SSS-Application Form

  • Western Nebraska Community College TRIO Student Support Services Application

  • All answers are confidential and reported as group data for program documentation and eligibility purposes only.

    Incomplete applications will not be processed.

  • PERSONAL INFORMATION:

  • Are you willing to receive text messages about events?*
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  • OR

  • Gender*
  • Ethnicity: Hispanic or Latinx?*
  • Race: Select one or more races that apply among the following:*
  • Citizenship:*
  • Campus you are attending (check all that apply):*
  • Are you a high school graduate?*
  • Did you receive a GED?
  • Referred by:

  • EDUCATIONAL & OCCUPATIONAL GOALS:

  • Do you already have a college degree? (If you have an associate’s degree or higher, you are NOT eligible for services.)*
  • If yes, what degree?
  • Long-Term Educational Goals*
  • Do you need assistance to enter the workforce due to limited marketable skills?*

  • ADDITIONAL INFORMATION:

  • Are you a veteran?*
  • Are you a parent?*
  • Are you a single parent?
  • ELIGIBILITY FOR SINGLE PARENT IN NETWORK PROGRAM (SPIN) SERVICES: Please check all boxes that apply to you:
  • Marital Status (please select one):
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  • PARTICIPATION AGREEMENT:

    By signing the TRIO application, I agree to adhere to and maintain the following standards to be considered eligible for SPiN services:

    • Maintain a cumulative GPA of 2.0 or above (newly enrolled students have limited financial assistance until their GPA is established).
    • You agree to meet with your assigned program advisor twice per semester.

  • ELIGIBILITY FOR SERVICES:

  • Do you have a disability as defined by Section 504 of the ADA (including a military disability)?*

  • Based on information from the most recent tax year.

  • Please select one of the following: *
  • I was a dependent student (younger than 24, unmarried or not emancipated; parental income is reported on the FAFSA).*
  • I was an independent student (typically age 24 or older, married, emancipated, or military veteran; parental income is not reported on the FAFSA).
  • Did a parent/adoptive parent complete a 4-year college degree before your 18th birthday?*
  • If yes, did that parent raise you more than 50% of the time?*
  • Is your taxable family income at or below the limits in the chart below? (Amount can be found on the 1040 U.S. Individual Income Tax Return- Line 15) *
  • Income Chart
  • Did a parent/adoptive parent complete a 4-year college degree before your 18th birthday?
  • Did you apply for Financial Assistance (FAFSA)?*
  • If yes, did you qualify?*

  • For family units with more than eight members, add the following amount for each additional family member: $8,520 for the 48 contiguous states, the District of Columbia, and outlying jurisdictions; $10,650 for Alaska; and $9,795 for Hawaii. The term “low-income individual” means an individual whose family’s taxable income for the preceding year did not exceed 150 percent of the poverty level amount. The figures shown under family income represent amounts equal to 150 percent of the family income levels established by the Census Bureau for determining poverty status. The poverty guidelines were published by the U.S. Department of Health and Human Services in the Federal Register on January 15, 2026, and are effective as of January 13, 2026.

  • Academic Needs:

  • Rows
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  • Which of the following services would you utilize in the WNCC TRIO SSS Program? (check all that apply):*
  • Did you participate in any pre-college programs (Upward Bound, Talent Search, Gear Up, or EOC)?*
  • Have you been in Foster Care or disconnected and/or homeless from your immediate family?*
  • Did you earn a high school equivalency (GED) diploma?*
  • Have you been out of the academic pipeline for 5+ years?*
  • Are you a Single parent? (Definition: A single parent must have sole or joint custody of a minor/disabled child or children.)*
  • Marital Status:
  • Rows
  • Are you a Veteran?*
  • Are you enrolled in developmental courses (such as Developmental Writing, Integrated Reading & Writing, Reading Techniques, Modular Math, Basic Math, Intro or Intermediate Algebra)?*
  • Are you prepared for college-level coursework?*
  • Are you on Financial Aid or Academic Probation?*
  • Is your GPA below 2.0, or did an instructor recommend SSS to you?*
  • Are you sure of your academic goals?*
  • Do you have clear career goals?*
  • Do you have limited English language skills?*
  • Do you need support for rigorous academic majors (ex: Nursing)?*
  • Are you working 20+ hours per week?*
  • Which of the following skills workshops would you be interested in? (check all that apply):

  • RELEASE OF INFORMATION:

  • By signing this form, I authorize the TRIO SSS staff to obtain all information and documentation necessary for the ongoing evaluation of my academic pursuits, including the information on file at WNCC, as required by the United States Department of Education. Furthermore, I agree to allow the SSS Program staff to release information to colleges to which I have applied for a transfer and to allow colleges to which I transfer to release information to the SSS program for tracking purposes. I certify that the information contained in this application is true and complete to the best of my knowledge. I understand that information on this application and in my TRIO SSS paper and electronic files may be provided to WNCC personnel as needed.

  • PARTICIPATION AGREEMENT:

  • By signing below, I agree to actively participate in the TRIO Student Support Service Program to support my work toward my academic, career, and professional goals by regularly receiving advising & other services (coaching, tutoring, workshops, etc.). An active participant is a student enrolled at WNCC with a minimum of 6 credit hours and has met with the SSS professional staff at least twice per academic year.

     

    I have read and understand my responsibilities as a TRIO SSS Program participant. I understand that the services and benefits of TRIO SSS are available to me based on my active program participation.

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  • TRIO Student Support Services is funded by the U.S. Department of Education
    A COPY OF THIS APPLICATION IS AS VALID AS THE ORIGINAL

  • Western Nebraska Community College • 1601 E. 27th St. Scottsbluff, NE 69361 • (308) 635-6190 • trio.team@wncc.edu

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