• Butte-Glenn Community College-SSS Application

    TRIO Student Support Services (SSS) Application
  • Date
     - -
  • Application for Semester

  • IMPORTANT! The Classic SSS program is designed for students who meet low-income or first generation eligibility. If you have a disability, or suspect you have a disability, please complete the Disabled SSS program application by going here.

    • Step 1: Demographic Information 
    • How did you hear about TRIO-SSS?
    • Date of Birth
       - -
    • Sex Identified at Birth
    • Gender Pronouns Used
    • Are you Hispanic or Latino?
    • Ethnicity
    • Are you a U.S. Citizen or Permanent Resident?*
    • Step 2: Education Information 
    • Are you still in high school?
    • Have you received your high school diploma or completed your GED?
    • Are you currently taking Butte College Courses?*
    • How many college units have you completed as of today?
    • How many units are you enrolled in this semester?
    • Do you plan on enrolling full-time next semester? (Full-time is 12+ units, 6-9 units if authorized by DSPS as an accommodation)*
    • Rows
    • Step 3: Program Information & Needs Assessment 
    • Are you registered with the Disabled Student Programs and Services (DSPS) program?*
    • What Butte College Student Services Programs are you currently participating in?
    • Have you ever attended any other college?
    • Did you receive a degree or certificate?
    • Have you ever been enrolled in a TRIO program?
    • If so, which one(s)?

    • Needs Assessment Questions

      Please carefully read each question and answer honestly. This helps us decide if you meet the eligibility needs for TRIO.
    • 1. Thinking about your most recent classroom/educational experience what areas do you STRUGGLE in the most:
    • 2. I utilize numerous campus resources to succeed (library, computer lab, CAS, instructor office hours).*
    • 3. I am involved in the Butte College community. (Student Organizations, Clubs, Active on Campus, Study with Friends/Classmates, etc. - New Butte College students may select no).*
    • 4. When I speak about my college experience with my family, they understand what I'm going through.*
    • 5. I have a positive mentor in my life, who has helped me improve on my weaknesses, and further my strengths*
    • 6. I would like opportunities to connect and engage with my fellow students.*
    • 7. I am confident in my ability to balance a monthly/annual budget.*
    • 8. I understand how credit works and how it’s linked with my financial history.*
    • 9. My housing and financial situation is stable. Not at risk of losing my home/being evicted. I can pay my bills on time*
    • 10. I have submitted the FAFSA application and received financial aid from Butte College.*
    • 11. I understand that financial aid may decline after 90 units and that maximum time frame or satisfactory academic progress appeals need to be submitted to the financial aid office if requested.*
    • 12. I am confident in my ability to search and apply for scholarships.*
    • 13. I plan to transfer to a 4-year college or university.*
    • 16. I am interested in researching and visiting my colleges/universities of interest.*
    • 17. What academic and career pathway have you chosen:*
    • 18. I understand how my education will prepare me for my career goal.*
    • 19. I would like to be connected to someone in my career interest area?*
    • 20. Do you have a current resume and cover letter.*
    • 21. Are you interested in obtaining and practicing interview skills?*
    • Step 4: Financial Aid Status and Eligibility Information 

    • NOTE: If you, the student, are less than 24 years old and are considered a DEPENDENT student, your parent/legal guardian MUST also read and sign this application below.

    • Did you submit your Free Application for Federal Student Aid (FAFSA) for the academic year?*
    • Which of the following were you awarded?
    • Are you a Veteran or a dependent using Veteran educational benefits?

    • Please answer the following questions to determine your dependency status.

    • Are you over the age of 25?*
    • Are you married? (Answer "yes" if separated, but not divorced)*
    • Do you have legal dependents (other than a spouse) who receive more than half their support from you?*
    • Are you a veteran or serving on active duty (for other than training purposes) in the U.S. Armed Forces?*
    • Are you, or prior to age 18, were you in foster care or a ward of the court?*

    • If you answered “yes” to any of the questions above, you are considered an INDEPENDENT student for financial aid reasons. You must provide YOUR taxable income. Skip to question #5 below.

    • Independent Students

    • Income Verification (Choose one option)

      **Please note: Taxable income is found on IRS Form 1040. This is NOT your Adjusted Gross Income (AGI)

      To process your application, you MUST list taxable income on this portion of the application.

      To find your taxable income review your 1040 tax forms and look at line 15, see copy of Form 1040 BELOW.

    • Form 1040

    • If you answered “no” to ALL of the questions above, you are considered a DEPENDENT student for financial aid reasons. You must provide the taxable income of your birth or adoptive parents below.

      Dependent Students

    • Income Verification (Choose one option)

      **Please note: Taxable income is found on IRS Form 1040. This is NOT your Adjusted Gross Income (AGI)

      To process your application, you MUST list taxable income on this portion of the application.

      To find your taxable income review your parents 1040 tax forms and look at line 15, see copy of Form 1040 ABOVE.

    • *Parent Signature is required for students who are under 24 years old and/or have been determined to be dependent for financial aid reasons

    • Release Statement & Agreement

      Please read carefully and then sign and date where indicated:

      Privacy Act Information

      In accordance with the Privacy Act of 1974 (Public Law No. 93-579, 5 U.S.C. 552a), you are hereby notified that the Department of Education is authorized to collect information to implement the Student Support Services program under the Title IV of the Higher Education Act of 1965, as amended (Pub. Law 102-325, Sec. 402D). In accordance with this authority, the Department receives and maintains personal information on participants in the Student Support Services program. The principle purpose for collecting this information is to administer the program, including tracking and evaluating participant progress. The information that is collected on this form will be retained in the program files and may be released to other Department officials in the performance of their official duties.

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

      · I understand that all information on this application, as well as that released from the school, will be held in strict confidence by the TRIO Student Support Services program staff.

      · I authorize the release of academic records (e.g. copies of school transcripts, test scores) to the Butte 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 consent to the disclosure of any personally identifiable information as defined by FERPA of my education records to the Butte College TRIO Student Support Services program staff for the purpose of confirmation of the student’s postsecondary enrollment status as reported on the National Student Clearinghouse Student Tracker. This authorization will remain in effect for six years following admission into the TRIO SSS program.

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

      · I authorize the TRIO Student Support Services program to share and discuss information with school personnel, including Disabled Student Programs & Services as appropriate, in support of my academic success.

      · I also give permission for the TRIO Student Support Services program to take photographs for identification purposes and during activities, and grant permission to use the student’s name, comments, and/or photos/videos for educational and/or promotional purposes.

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

    • Date*
       - -
    • Submit 
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