Allan Hancock College-SSS-Application Form

Personal information is protected by the Privacy Act of 1974; only authorized individuals and the U.S. Dept. of Education have access to the information provided. The information provided is used to determine eligibility to the College Achievement Now (CAN) - TRIO Student Support Services Program (SSS) at Allan Hancock College (AHC).

1. Name:*

First NameLast Name

2. H#:*

3. Phone Number:*

(999)999-9999

Can you receive texts at this #:*

YesNo

AHC Student Email*

example@example.com

4. Ethnicity*

5. Are you a U.S. Citizen or Permanent Resident?*

YesNo

Are you an AB 540 or DACA student?*

YesNo

(Federal Regulations require the CAN-TRIO Program at AHC to obtain household and income information to determine eligibility for each student applying to participate.)

6. Did either of your parents or guardians graduated and received a bachelor’s degree from a four-year college or university?*

YesNo

7. Do you have any physical or learning disabilities?*

YesNo

If yes, are you registered with the Learning Assistance Program at AHC?*

YesNo

8. Are you currently enrolled full-time at AHC. (Full-time is 12 units or more, 9 units if in LAP)*

YesNo

9. If applicable, what is your college GPA*

10. What areas best describe your academic need (s)? (Check all that apply)*

11. What is your academic goal at Allan Hancock College?*

UndecidedCertificateAssociate degreeAA/AS and Transfer

a. What is your Major?*

Please list all colleges and universities you are interested in attending after graduating from AHC and explain your educational and/or career goals

12. Are you a participant in any of the following programs? Check all that apply*

15. Did you file a Free Application for Federal Student Aid (FAFSA)?*

YesNo

Did you file a CA DREAM ACT (CADAA)?*

YesNo

For financial aid purposes, are you considered a dependent or independent student

DependentIndependent

How do I know if I am an independent or dependent student

If you are considered an INDEPENDENT student for financial aid reasons, you must provide YOUR information and taxable income below. If you are considered a DEPENDENT student for financial aid reasons, you must provide the information and taxable income of your natural or adoptive parents below.

13. Please indicate household size:*

Federal Regulations require the TRIO/SSS Program at AHC to obtain household and income information to determine eligibility for each student applying to participate.

14. Please indicate total family annual TAXABLE INCOME from 2022 or 2023: Taxable Income is the total AFTER your deductions are taken. This can be found using the IRS form 1040: use line 11b;*

*Please provide a copy of your tax return with this application (if 24 years or older) or your parents/guardian tax return from the most recent tax year 2022 or 2023 federal 1040 form (1040 EZ or 1040A form). If you or your parents/guardian do not file taxes please provide proof of all other income or assistance when submitting this application.

Disclosure Statement

The TRIO/SSS Program at AHC is funded through a Federal TRIO Grant from the U.S. Department of Education. Annual Funding (2024-2025) is $261,888 (100%) total funds.

EQUAL OPPORTUNITY

Thank you for your interest in the TRIO/Student Support Services Program at Allan Hancock College. All applicants will be considered without regard to race, color, religion, national origin, sexual orientation, marital status or disability.

DECLARATION

By signing this application, I certify that all information provided above is true and accurate to the best of my knowledge and belief.

I hereby authorize the release of academic records and financial records to the Allan Hancock College TRIO Student Support Services program in order to assess need/eligibility for program services, discern academic progress, evaluate the effectiveness of program activities, and fulfill program reporting requirements.

I authorize the release and exchange of student financial aid information from colleges and federal government to the TRIO Student Support Services program.

I understand that this authorization will remain in effect while the student is enrolled in the Allan Hancock College TRIO Student Support Services program or until written notice is provided to revoke the authorization.

Signature:*

Date*

mm-dd-yyyy

CAN-TRIO Application

DEMOGRAPHIC INFORMATION

ELIGIBILITY

EDUCATIONAL INFORMATION

FINANCIAL AID ELIGIBILITY AND STATUS