Central Piedmont Community College-SSS-2024 Application Form

Central Piedmont's TRIO Student Support Services (SSS) is a college retention and degree completion program centered on academic, personal, social and career support for qualified students. TRIO SSS provides students with no cost success coaching, tutoring, and counseling services to help increase retention, persistence, degree completion and transfers to 4-year institutions. TRIO SSS is a federally funded program grant through funds provided through the U.S. Department of Education.

Program Qualifications

Student must meet one or more of the following

1. First-generation college student (neither parent has a 4-year degree)

2. Low income eligible as defined by the Federal Government. For income limits, visit Federal TRIO Programs Current-Year Low-Income Levels | U.S. Department of Education

3.Disabled (must provide accommodations plan from the Office of Disability & Access Services.

CPCC TRIO Student Support Services

Central Campus, Central High, Room 322

(704) 330.3396

triosss@cpcc.edu
Please select your dependency status as indicated on your most recent FAFSA application
- Full Name:
  
  First NameM.I.Last Name
- Student ID#:
- Current Address:
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Best contact number:
  (999)999-9999
- I give TRIO consent to text this number
- Date of Birth:
  
  MonthDayYear
  mm-dd-yyyy
- Gender:
- CP email:
  example@example.com
- Emergency Contact:
  
  First NameLast Name
- Relationship:
- Contact #
  (999)999-9999
- Racial or Ethnic Group (select all that apply):
  
  Other
- U.S. citizen or Permanent Resident:
  
  Other
- Veteran Status:
- Do you have a disability? (Note: If yes, students will be required to submit their accommodations plan from the Office of Disability & Access Services)
- Does your MOTHER have a bachelor’s (4-year college/university) degree or higher
- Does your FATHER have a bachelor’s (4-year college/university) degree or higher
- Did you receive the Pell Grant for this academic year?
- Identify the highest level of education you have COMPLETED
- What are plans at Central Piedmont Community College
- If you are planning to transfer, what schools are you interested in transferring to?
- Date
  
  MonthDayYear
  mm-dd-yyyy
- Expected Graduation Date:
  
  MonthDayYear
  mm-dd-yyyy
- Program of Study:
- Minor(s):
- Are you interested in transferring to a 4-year college or university?
- If yes, where:
- FIRST GENERATION CRITERIA: Before you turned 18, did either parent or guardian with whom you reside/resided have a bachelor’s degree?
- Mother/Female Guardian
- Father/Male Guardian
- Eligibility to participate in Central Piedmont Community College TRIO SSS may be established based on taxable income, first generation status and/or a documented disability. Please answer the following questions to establish your eligibility.
- If NO, are you a non-U.S. citizen eligible to receive Federal Student Aid (Pell Grant)?
- Are you a high school graduate?
- If no, have you earned your high school equivalency (GED)?
- Did you graduate from college with a Bachelor's degree?
- If yes, where?
- If you have a degree, you do not qualify for TRIO SSS.
- I certify that this information provided regarding my first-generation eligibility is valid and correct to the best of my knowledge.
- Student Signature
  
  Clear
- Name
  
  First NameLast Name
- Date Signed
  
  MonthDayYear
  Date
- If YES, you must provide a copy of your accommodations plan with Central Piedmont’s Office of Disability & Access Services.
- Only complete one income verification option below depending on your student status as listed on your moset recent FAFSA form.
  
  Option 1: For DEPENDENT students who are claimed on parent tax return (Information from 2023 tax return)
- (check only one):
- Did the parent file a tax return?
- If you filed, what was your taxable income (IRS Form 1040, Line 15)
- How many people are in your family (including yourself)?
- I certify the above information regarding my income eligibility is valid and correct to the best of my knowledge.
- Parent Signature
  
  Clear
- Parent Name
  
  First NameLast Name
- Date
  
  MonthDayYear
  Date
- • Option 2: For INDEPENDENT students who are NOT claimed on parent tax return (Information from 2023 tax return)
- Did you file a tax return?
- If you filed, what was your taxable income (IRS Form 1040, Line 15)
- How many people are in your family (including yourself)?
- I certify the above information regarding my income eligibility is valid and correct to the best of my knowledge.
- Student Signature
  
  Clear
- Student Name
  
  First NameLast Name
- Date
  
  MonthDayYear
  Date
- INCOME CRITERIA: Did you receive the federal Pell Grant for this current academic year?
- Dependency Information (select only one option)
- Income Information (REQUIRED: only complete one option, BASED on your above to the dependency information). Option A must be completed by your parent/guardian.
  A. DEPENDENT STUDENTS (claimed on parent(s) tax return)
- B. INDEPENDENT STUDENTS (NOT claimed on parent(s) tax return)
- TRIO SSS provides robust support and interventions to assist you on your academic journey at Central Piedmont Community College. Identify your areas of interest by selecting all that apply.
- Have you participated in any of the following TRIO programs?
- If yes, at which school?
- All accepted participants must actively participate in the TRIO program and attend all scheduled tutoring, coaching, and/or counseling meeting. Each semester, participants are required to complete 2 coaching sessions and attend a minimum of 2 activities/events/tutoring/workshops.
  
  I certify that all the information I have provided is true and accurate. Upon request, I will provide any further documentation as requested. I understand the information collected will be confidential and used to determine my eligibility status for TRIO SSS.
  
  Upon acceptance, I give permission for TRIO SSS to obtain information pertaining to my academics and financial aid status for communication purposes, program eligibility and to assist with program reporting needs.
  
  I give consent to TRIO SSS for photographs, motion pictures, or videotapes being taken of me by persons acting with the permission of and the authority of Central Piedmont Community College and authorize their use in accordance with Central Piedmont’s policy.
  
  I certify all information provided in this application is true to the best of my knowledge.
- Student Full Name
  
  First NameLast Name
- Date
  
  MonthDayYear
  mm-dd-yyyy
- Student Signature
  
  Clear
- TRIO SSS
  
  Central Piedmont Community College
  
  Dependent Only Income Verification
  
  Must be completed by the parent/guardian.
- What was the TAXABLE INCOME reported on your parent(s) tax return? (ex. Form 1040, line 15)
- How many people were in the household, including yourself?
- If your parent(s) did not file a tax return, what was the reason?
- Parent Signature Required
  I am the parent/legal guardian of the applicant. I acknowledge and certify that all information provided above is true to the best of my knowledge
- Parent Name
  
  First NameLast Name
- Signature
  
  Clear
- TRIO SSS
  
  Central Piedmont Community College
  
  Independent Only Income Verification
- What was the TAXABLE INCOME reported on your tax return? (ex. Form 1040, line 15)
- How many people were in the household, including yourself?
- If you did not file a tax return, what was the reason?
- Student Signature Required
  
  I acknowledge and certify that all information provided above is true to the best of my knowledge
- Student Name
  
  First NameLast Name
- Signature
  
  Clear