Orangeburg Calhoun Technical College-SSS-Application Form

Orangeburg-Calhoun Technical College TRIO SSS Program Application for Participation
3250 St. Matthews Road, Orangeburg, SC 29118-8299
Telephone: (803) 535-1463 Fax: (803) 535-1368
Student's Name:

First NameMiddle NameLast Name
Student ID#
Date of Birth

MonthDayYear
mm-dd-yyyy
Age:
Gender:
Physical Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Number:
(999)999-9999
Cellular/Mobile:
(999)999-9999
OCtech email:
example@example.com
Other email:
example@example.com
PLEASE ANSWER ALL OF THE FOLLOWING QUESTIONS
1. Do you have a 4-year college degree?
Do you have a 2-year college degree?
2. Parents’ Education: Mother has a 4-year college degree?
2. Parents’ Education: Father has a 4-year college degree?
3. Prior to the age of 18, did you not live with or receive support from a natural or adoptive parent and considered an orphan or ward of the court?
4. Have you applied for FAFSA (Financial Aid)?
5. Are you receiving a Federal Pell Grant?
6. Are you receiving Financial Aid?
7. Do you have a documented disability?
8. Are you a Citizen/National/Permanent Resident of the United States?
9. Is English your first language?
10. Did you:
11. What year did you graduate high school or complete your GED?
12. Ethnicity (please check all that apply)

Other
13. Have you ever participated in any of the following TRIO Programs? (please check all that apply)
14. Did you enter OCtech as a:
15. Semester & Year entered OCtech:
16. Current classification as of this semester?
17. Are you classified as:
18. While at OC Tech, which describes your program of study?

For occupational upgrade, but not for degree/certificate. Major:
19. Do you plan to transfer to another institution?
20. What is your cumulative GPA?
ACADEMIC NEED (check all that apply)

11 - Other:
Income Documentation
As we are funded through a grant from the U.S. Department of Education, and for grant compliance, we require supporting documentation to verify your eligibility for our program. Please take a moment to read and complete the information below. We assure you that this information will be kept confidential and will only be reviewed by the TRIO-SSS Staff.

Please provide the TRIO-SSS program with a signed copy of the Most Recent Federal Income Tax Return Form or Your Student Aid Report. You may also document your income information by completing the information below and signing this document.
Please check ONE of the following that you will be submitting:
(For the official definition of Dependent and Independent, please refer to the lower half of the form)
If you “Did Not File Taxes” (please check box):
What Year(s) Did You Not File Federal Income Taxes:
Year(s)
Size of Family: (refers to the number of people living in a household) (check one)
Income Level:
I affirm that the financial documentation or information that I am voluntarily submitting to the TRIO-SSS program is true to the best of my knowledge.
Student Name:

First NameLast Name
Student Signature:
Date:

MonthDayYear
mm-dd-yyyy
PARENT SIGNATURE IS REQUIRED ONLY IF YOU ARE A DEPENDENT
Parent Name:

First NameLast Name
Parent Signature:
Date:

MonthDayYear
mm-dd-yyyy
For Federal Financial Aid purposes, a student may be considered DEPENDENT if she/he can answer NO TO ALL of the following questions at the time she/he complete and sign the Free Application for Federal Student Aid (FAFSA):

· Will you be 24 or older by December 31 of the school year for which you are applying for financial aid?

· Will you be working towards a master’s or doctoral degree (such as MA, MBA, MD, JD, PhD, EdD, etc.)?

· Are you married or separated but not divorced?

· Do you have children who receive more than half of their support from you?

· Do you have dependents (other than children or a spouse) who live with you and receive more than half of their support from you?

· At any time since you turned age 13, were both of your parents deceased, were you in foster care, or were you a ward or dependent of the court?

· Are you an emancipated minor or are you in a legal guardianship as determined by a court?

· Are you an unaccompanied youth who is homeless or self-supporting and at risk of being homeless?

· Are you currently serving on active duty in the U.S. armed forces for purposes other than training?

· Are you a veteran of the U.S. armed forces?

*If you answered YES to one or more of the questions above, then for federal student aid purposes, you are considered to be an INDEPENDENT student and will not need to provide information about your parents.

**If you answered No to all of the questions above, then for federal student aid purposes, you are considered to be a DEPENDENT student and must provide information about your parents.
Orangeburg-Calhoun Technical College – TRIO SSS Photo Release
Name

First NameLast Name
I, {name}, give Orangeburg-Calhoun Technical College, TRIO-SSS program, the absolute right and permission to use my photograph in its promotional materials and publicity efforts. I understand that the photographs may be used in a publication, print, a direct-mail piece, electronic media (i.e., video, DVD, Internet/WWW, social media platforms), or other forms of promotion. I release Orangeburg-Calhoun Technical College, the TRIO-SSS program, the photographer, their offices, employees, agents, and designees from liability for any violation of any personal or proprietary right I may have in connection with such use. I am 18 years of age or older.
Student Signature
Date:

MonthDayYear
mm-dd-yyyy
Authorization and Verification
1. I understand that the TRIO-SSS program is funded through a federal grant from the U.S. Department of Education and is required to verify my eligibility utilizing the information included in this application & supporting documents.

2. I hereby authorize Orangeburg-Calhoun Technical College’s TRIO-SSS staff to obtain academic, financial, and other information pertinent to my participation in the TRIO-Student Support Services program.

3. I understand that my application and its contents will be kept in a file at the TRIO-SSS program office, and will be kept confidential in compliance with the Family Educational Rights Rights and Privacy Act (FERPA).

4. I also understand that the TRIO-SSS program is not responsible for any grades I receive. The program is only responsible for the clarification of subject matter and for suggestions on how to improve my chances for success.

5. I understand that completion of this form does NOT guarantee acceptance into the TRIO-SSS program.

6. I certify that the information contained herein is true and complete to the best of my knowledge.

7. I understand that I should maintain an open mind and positive attitude towards students, peer tutors/coaches, and other TRIO-SSS staff members.

8. Be a responsible student and adhere to the Orangeburg-Calhoun Technical College Student Conduct Code.

9. I understand that once I am accepted into the TRIO-SSS program, I have a participant obligation to update my files as requested by the program and remain in active status.

10. If, for any reason, the Director feels that your participation is detrimental to the program or other students, you will be dismissed/removed.
Student Signature:
Date:

MonthDayYear
mm-dd-yyyy
Parent/ Guardian Signature:
(Required if the applicant is under the age of 18)
Date:

MonthDayYear
mm-dd-yyyy
Orangeburg-Calhoun Technical College does not discriminate on the basis of sex, race, disability, national or ethnic origins in the administration of admissions policies, educational policies, scholarships, and loan programs, and other college-administered programs.

Orangeburg-Calhoun Technical College TRIO SSS Program Application for Participation

PLEASE ANSWER ALL OF THE FOLLOWING QUESTIONS

Income Documentation

Orangeburg-Calhoun Technical College – TRIO SSS Photo Release

Authorization and Verification