Texas A & M University-Corpus Christi-Teacher-SSS-Application Form

First NameMiddle InitialLast Name

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

@islander.tamucc.edu

FreshmanSophomoreJuniorSenior

YesNO, but I am a Permanent Resident.NO; I am not a U.S. citizen, and I am not a permanent resident

Both Mother and FatherNeither Mother and FatherMother onlyFather only

You must answer the following questions about yourself if you are at least 24 years old or if you answered YES to any question in STEP 5.
Your parent(s) must answer the following questions about themselves if you are less than 24 years old and you answered NO to all questions in STEP 5.

What was your family’s taxable(not total) income from the last calendar year?

Please read the following statement and then sign and date below it. If you (the student) are less than 24 years old and answered NO to all the questions in STEP 5, your parent or legal guardian must also read the following statement and then sign and date below it.

By signing this application, I attest that all the information on this application is true. Moreover, I authorize the release of the student’s official academic records to the TRIO Student Support Services (SSS) project at Texas A&M University-Corpus Christi, understanding that the information in these records will be used only to assess the student’s need for TRIO program services, discern the student’s educational progress, evaluate the effectiveness of TRIO program activities, and fulfill TRIO program-reporting requirements. Finally, I authorize this SSS project to use the student’s name, statements, and likeness, without charge, for promotional purposes in the project’s publications, advertising, video, and other formats.

Participant Application