University Of Cincinnati-Clifton-SSS-Application Form

University of Cincinnati - Clifton Student Support Services

You can't spell success without SSS
Thank you for your interest in the TRIO Student Support Services program at UC Clifton (TRIO SSS-UC Clifton)! Please complete all required parts of this application to the best of your ability. All fields marked with * are required and must be filled to submit.

Applications are accepted on a rolling basis

If you have any questions about completing this application or if you have any questions about admissions into our program, please contact our office at triosssclifton@uc.edu

Personal Information
Student Name*

First NameMiddle InitialLast Name
Preferred Student Name (if different from above)

First NameLast Name
Date of Birth*

MonthDayYear
Date
UC Student ID Number*
UC Student Email Address*
example@example.com
Alternate Email Address
example@example.com
Cell Phone Number*
(999)999-9999
Alternate Phone Number
(999)999-9999
Campus/Local Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Permanent Mailing address (if different that Campus/Local Mailing Address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Best way to contact (Check all that apply)*

EmailText MessagePhone Call
Referred by:

Academic Information
Current Class Level*

Freshman (0 to less than 30 credit hours)Sophomore (30 to less than 60 credit hours)Junior (60 to less than 90 credit hours)Senior (90+ credit hours)
First term at UC Clifton (selection the term below that your start(ed) at UC)*

FallSpringSummer
First year at UC Clifton (type the year below that you start(ed) at UC)*
Are you a Transfer/Transition student?*

YesNo
If yes, where are you transferring from?*
Current Major*
Current Minor

Eligibility Information
What is your U.S. Citizenship status?*

U.S. CitizenPermanent ResidentNone of the above
What is the highest level of education COMPLETED by your mother/guardian?*
What is the highest level of education COMPLETED by your father/guardian?*
Do you have a documented disability?*

Yes (if yes, please attach your documentation/accommodations letter)No
Students who are interesting in receiving accommodations to lessen the impact of their disability should consider registering with Accessibility Resources. Accommodations are determined on an individual basis to directly address barriers the student is experiencing based on the impact of their disability. Students who are interested in registering for services should visit the UC Accommodate website and complete an online application. After submitting an application, students will receive a request to schedule a meeting with an Access Coordinator, who will serve as the primary point of contact for accommodations, access issues, advocacy, and support regarding disability related issues. During the registration meeting, the student will discuss the impact of their disability within the academic or residential setting and if deemed appropriate, reasonable accommodations will be determined.
Please attach your documentation/accomodations letter

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Income Verification Acknowledgement
The TRIO Student Support Services program is a federal TRIO Program that requires documentation to certify a student’s eligibility in compliance with U.S. Department of Education regulations. All information provided to verify eligibility, including income information, will be used solely for this purpose.

You can verify income in two ways for our program. Option 1 is to submit your and/or your parents/guardians signed 2024 Income Tax Return (first two pages of Form 1040 showing line 15 and signature) or Tax Transcript (please redact all social security numbers). Option 2 is to complete the taxable income statement from the TRIO Student Support Services Office. A TRIO SSS staff member will reach out to you to provide you with this form upon completion and submission of this application.

Either option can be submitted to our office via email at triosssclifton@ucmail.uc.edu or a copy can be given to our staff directly. Our offices are currently located in Stratford Heights Building 12, Impact House (2639 Stratford Ave) Rm. 119.

Please indicate and sign below that you understand that income verification is an additional requirement after the submission of this initial application to be apart of our program.
I understand that to complete my TRIO SSS application I will need to verify my household income and family size by either:*

Submitting my parents/guardians or mine signed 2024 Income tax return of Tax transcript showing taxable or earned income orSubmit a singed Income Statement from the TRIO SSS office stating my parents/guardians or my family size and taxable income. TRIO SSS staff will be reaching out with this form after submission of this application.
The TRIO Student Support Services program is a federal TRIO Program that requires documentation to certify a student's eligibility in compliance with U.S. Department of Education regulations. All information provided to verify eligibility, including the information in this form, will be used solely for this purpose.

You can verify taxable income in two ways. Option 1 is to submit your 2024 signed Income Tax return (first page of 1040 form showing line 15) or Transcript (Redact all social security numbers). Option 2 is to complete the Taxable Income statement below. Taxable income can be found on line 15 of Form 1040.

If you are a dependent student per FAFSA guidelines, please include your parent/guardian's income information.
Are you a dependent student per the FAFSA guidelines?*

YesNo
Chosen method of income verification*

Option 1: Signed income tax return or tax transcript included. I am including my and/or my parents or my guardian's signed income tax return or transcript for 2024 with this application.Option 2: Statement including family taxable income and family size.
Signed Income Tax Return or Tax Transcript*

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Please check one of the two statements below regarding you and/or your parents/guardians most recently filed federal income tax return and enter the requested income and household size information.*

I and/or my parents/guardians did NOT file a tax return for 2024.I and/or my parents/guardians did file a tax return for 2024.
Family Taxable/Earned Income (line 15 on Form 1040)*
Family Size*
Student Signature*

Clear
Today's Date*

MonthDayYear
Date
Parent/Guardian Signature *

Clear
Today's Date*

MonthDayYear
Date

Programmatic Information
To help us understand a little more about who you are and why you are interested in our program, please take a few minutes to provide us with 3-4 sentences to the questions below.
What motivated you to apply for TRIO SSS at Clifton?*
What do you hope to gain from participating in our program?*

Verification and Authorization to Educational Institution
Please read and indicate your acceptance

My acknowledgement below indicates that, to the best of my knowledge, the information given on this application is true, complete, and accurate. In accordance with the Family Educational Rights and Privacy Act of 1974, I hereby authorize the University of Cincinanati to release to the Director and staff of the TRIO Student Success Program any and all information (academic, financial, addresses, references, etc.) that may be pertinent to consideration of my application to the Student Success Services program.

My acknowledgement below also authorizes UC Student Support Services Administrators/Staff to access, monitor, and database academic information from the institution in which I was, or am currently, enrolled (e.g. graduate school, alma mater, etc.) to determine academic and/or income eligibility for the program and to monitor enrollment status and progress to completion in undergraduate education.
Student Signature*

Clear
Today's Date*

MonthDayYear
Date

University of Cincinnati - Clifton Student Support Services

To help us understand a little more about who you are and why you are interested in our program, please take a few minutes to provide us with 3-4 sentences to the questions below.