300855-Eastern New Mexico University-Roswell-SSS-2024 Application Form-Stephen

Application for SSS Program Services
PERSONAL DATA
Name:*

First NameMiddle NameLast Name
Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone #:
(999)999-9999
Student Email:*
example@example.com
Social Security #:
999-99-9999
Student ID #:
Gender:

MaleFemaleNonbinary or another genderNo response/Unknown
Date of Birth

MonthDayYear
mm-dd-yyyy
Race/Ethnicity (please check one)

American Indian/Alaskan NativeAsianBlack/African AmericanNative Hawaiian/Pacific IslanderWhite
Please Select the applicable ethnicity:

HispanicNon-Hispanic
CITIZENSHIP ELIGIBILITY (please check one)
Citizenship:

U.S. CitizenU.S. Permanent ResidentTerritorial ResidentOther
Financial Information
FINANCIAL INFORMATION ELIGIBILITY (Please submit a copy of the most recent taxes)

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For Independent Students:
Taxable Income:
Size of Family Unit:
For Dependent Students:
Taxable Income:
Size of Family Unit:
CAREER/ACADEMIC PLAN
Do you plan to complete an Associate’s Degree at ENMU-Roswell?

YesNo
Do you plan to transfer to a Four-Year University for a Bachelor’s degree?

YesNo
Do you plan to be a full-time student until you complete your degree?

YesNo
What is your Major/Degree Plan?
VETERAN STATUS
Are you a Veteran of the United States Armed Forces?

YesNo
If yes, please attach documentation

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STUDENT STATEMENT

(please read, sign and date)
I authorize TRiO SSS staff to gather information (standardized test scores, FAFSA application, GPA, transcripts, social security #, etc.) concerning my academic progress and financial status prior to my participation in TRiO SSS. I understand this information is used to assist in the determination of my eligibility for the program and it will be kept strictly confidential. I am aware that personal information provided to TRiO will be protected under the Family Education Rights & Privacy Act (FERPA) of 1974. I certify that the information provided on the application is true and complete to the best of my knowledge.

I authorize TRiO SSS staff to send emails, texts, and phone calls pertaining to the SSS program and services.
Student Signature:

Clear
Date

MonthDayYear
mm-dd-yyyy
Eligibility Assessment Information:
Do you have a current FAFSA on file at ENMU-Roswell?

YesNo
Has your mother received a Bachelor’s Degree?

YesNo
Has your father received a Bachelor’s Degree?

YesNo
Are you Disabled?

YesNo
If yes, you are required to provide documentation to support your answer

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TRIO SSS Needs Assessment Information:
Please select the areas in which assistance would be beneficial:

Choosing a Major/CareerTutoringGetting OrganizedGoal SettingTime ManagementMathematicsTest-Taking MotivationFinancial AidWritingNote-TakingSelf-EsteemBudget/FinancesReadingAdvisingTransferring to a 4-year schoolOther
How did you discover TRIO Student Support Services (TRIO SSS)?
What are your expectations of the TRIO SSS Program?
How do you anticipate TRIO SSS will benefit your academic, professional, and/or personal goals?
What are your educational and/career plans after graduating from ENMU-Roswell?
Our grant allows us to accept and serve only 140 participants per academic year. What qualifications make you an excellent candidate for the TRIO SSS Program?
In our efforts to assist you, is there any additional information of which you would like to make us aware?
Acknowledgement and Consent
APPLICATION REVIEW REQUIREMENTS - Please read and sign the following statement:

I am aware my TRIO Student Support Services Program Application will not be reviewed until all documentation, including IRS 1040 Forms/ Statement of Non-Filing Forms, has been received by the TRIO SSS Office. Missing documentation or incomplete information will result in the application being eliminated from the application process and, therefore, deemed ineligible for review.

FERPA RELEASE - Please read and sign the following statement:

In accordance with the Family Education Rights and Privacy Act of 1974, I hereby acknowledge and authorize the release and/or exchange of my records in reference to academic information (enrollments status, academic transcript, grade point averages, registration status, class schedule, etc.), financial aid information (financial aid application data, financial aid eligibility, financial aid awards, financial aid disbursements, financial aid academic progress status, etc.), loan information (University-maintained loan disbursements, billing, and repayment history balances, collection activity, etc.), student account information (billing statements, charges, credits, payments, past due amounts, collection activity, etc.), and any other pertinent information with the Eastern New Mexico University TRIO Student Support Services Program and Staff. I understand the U.S. Department of Education requires the submission of TRIO SSS Participant demographic, participation, and academic data. By signing below, I acknowledge and authorize the release of any and all of my educational and TRIO SSS programmatic information to third-party agencies, including but not limited to the U.S. Department of Education, TRIO SSS database entities, and National Student Clearinghouse.

APPLICATION CERTIFICATION - Please read and sign the following statement:

I certify that the information provided on this application is accurate and complete to the best of my knowledge.
Signature:

Clear
Date

MonthDayYear
mm-dd-yyyy

Application for SSS Program Services

PERSONAL DATA

Financial Information

CAREER/ACADEMIC PLAN

VETERAN STATUS

STUDENT STATEMENT

Eligibility Assessment Information:

TRIO SSS Needs Assessment Information:

Acknowledgement and Consent