Clone of 282771-Columbus State Community College-STEM-SSS-2023 Application Form-Joseph

Student Support Services

Columbus State Community College

The TRIO Student Support Services is an intensive academic support program, which works with a limited number of students per year and has a low coach to student ratio. Applicants must meet the following requirements to be eligible for enrollment in the program:
- Be a first generation college student (meaning neither of your parents have a four-year college degree), a student with a documented disability and/or income eligible student.
- Be a U.S. Citizen OR financial aid eligible non-citizen
- Be registered for classes at Columbus State Community College.
- Be enrolled in an Associate Degree program at Columbus State Community College.
The information requested is needed to determine the student’s eligibility for this program. Applications are evaluated as they are received and eligible students are admitted until the program is full. Please complete this application which contains the following forms:



            First Generation College Eligibility Form

            Income Verification Form

Release of Academic Information

Photo Release Form

Needs Assessment

Commitment to Participate

You must include the following with your application:
- A completed Income Verification form signed by Independent students and Dependent student and parent. Dependency is determined by the Dependency Status Questions on the FAFSA.
- If you are not a United States citizen, you must enter your Permanent Resident number.
Please make sure that the application is complete and that all signature lines are signed.

All information you provide is confidential and is for educational purposes only.

Has either parent received a Bachelor’s Degree?
Please specify who
I certify that this information I have provided regarding my first generation eligibility is valid and correct to the best of my knowledge.
Student's Signature
Name

First NameLast Name
Date Signed

MonthDayYear
mm-dd-yyyy

Photo Release

I hereby grant Columbus State Community College and its Student Support Services program permission to use my photograph or other likeness in any and all of its publications, including website entries, without payment or any other consideration. I understand and agree these photographs or materials will become the property of the CSCC Student Support Services program and will not be returned to me.

In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. Additionally, I waive my right to royalties or other compensation arising or related to the use of the photograph or materials.
Student's Signature
Name

First NameLast Name
Date Signed

MonthDayYear
mm-dd-yyyy

ACADEMIC INFORMATION RELEASE
Columbus State Community College

Student Support Services STEM

I understand that TRIO/SSS STEM staff members have access to the College’s student information system and therefore have access to my student schedule, academic history including courses completed and GPA, and my financial aid award. In addition, TRIO/SSS STEM staff can access my current course information through Starfish/Blackboard. I authorize the TRIO/SSS STEM staff to access this information in order to verify my eligibility for enrollment in the TRIO/SSS STEM program and to track my progress toward degree completion.

In accordance with the Family Educational Rights and Privacy Act (FERPA), (20.U.S.C Section 1232g) I authorize SSS STEM to obtain information related to my application for college admission and acceptance status, financial aid application (FAFSA), and award letter at any and all colleges and universities I may transfer to, as well as current enrollment status and/or number of credits enrolled. In addition, I authorize SSS STEM staff to obtain and or disclose this information from an outside reporting agency when necessary.

I understand that TRIO/SSS STEM will report this information to the U.S. Department of Education in accordance with grant funding regulation regarding end of year reporting.
Columbus State Community College

Student Support Services

I understand that TRIO/SSS is an institutional program operated by the College. As part of administering services and documenting participation and outcomes, TRIO/SSS may use student information maintained by the College and its learning platforms (including the College’s student information system and Prism/Blackboard), consistent with applicable federal and institutional privacy rules.

In accordance with the Family Educational Rights and Privacy Act (FERPA), 20 U.S.C. § 1232g, I authorize the College’s TRIO/SSS program to obtain, request, receive, and verify information necessary to determine and document my eligibility for TRIO/SSS services and to meet federal grant requirements. This information may include, but is not limited to, my application for college admission and acceptance status, enrollment status (including number of credits enrolled), attendance, academic standing, academic records such as course enrollment and completion, GPA, persistence/retention, and progress toward degree or certificate completion, as well as financial aid application and award information, including FAFSA status and financial aid award details. I further authorize TRIO/SSS to request and obtain such information at any college or university I attend or may transfer to, and, when necessary, to obtain and verify related information from outside entities or reporting agencies that maintain enrollment, financial aid, completion, or employment-related data for program evaluation or required reporting.

I also authorize TRIO/SSS and the College to disclose the information described above to the U.S. Department of Education and/or the U.S. Department of Labor, including their authorized representatives, solely for purposes of confirming eligibility for grant-funded services, monitoring compliance with grant requirements, completing required performance, evaluation, and end-of-year reporting, and fulfilling audits, reviews, or other oversight activities required by the terms of the grant.

I understand that any information disclosed under this authorization will be shared only as needed to support TRIO/SSS grant eligibility verification and required federal reporting or oversight. This authorization will remain in effect while I am a TRIO/SSS participant and for any additional period required for grant record retention, audit, or reporting obligations, unless I revoke it earlier in writing. I understand that I may revoke this authorization at any time by submitting a written request to the TRIO/SSS office; however, revocation will not apply to information already obtained or disclosed in reliance on this authorization prior to the date the revocation is received.

By signing below, I acknowledge that I have read and understand this authorization.
Student's Signature
Name

First NameLast Name
Date Signed

MonthDayYear
mm-dd-yyyy

Student Name

First NameMILast Name

Dependency Status Questions on the 2026-2027 FAFSA® Form

Rows	Yes	No
Were you born before Jan. 1, 2003?
As of today, are you married? (Also answer “Yes” if you are separated but not divorced.)
At the beginning of the 2026-2027 school year, will you be working on a master’s or doctorate program (such as an M.A., M.B.A., M.D., J.D., Ph.D., Ed.D., graduate certificate, etc.)?
Are you currently serving on active duty in the U.S. armed forces for purposes other than training? (If you are a National Guard or Reserves enlistee, are you on active duty for other than state or training purposes?)
Are you a veteran of the U.S. armed forces?*
Do you now have—or will you have—children who will receive more than half of their support from you between July 1, 2026, and June 30, 2027?
Do you have dependents (other than your children or spouse) who live with you and who receive more than half of their support from you, now and through June 30, 2027?
At any time since you turned age 13, were both your parents deceased, were you in foster care, or were you a dependent or ward of the court?
Has it been determined by a court in your state of legal residence that you are an emancipated minor or that someone other than your parent or stepparent has legal guardianship of you? (You also should answer "Yes" if you are now an adult but were in legal guardianship or were an emancipated minor immediately before you reached the age of being an adult in your state. Answer "No" if the court papers say "custody" rather than "guardianship.")
At any time on or after July 1, 2025, were you determined to be an unaccompanied youth who was homeless or were self-supporting and at risk of being homeless, as determined by (a) your high school or district homeless liaison, (b) the director of an emergency shelter or transitional housing program funded by the U.S. Department of Housing and Urban Development, or (c) the director of a runaway or homeless youth basic center or transitional living program?**

Your answers above determine if you were considered an Independent or Dependent student for the purposes of financial aid eligibility on the 2026-2027 FAFSA.

If you answered yes to at least one question you are an Independent student. If you answered no to all questions, you are a Dependent student.
I answered yes to at least one question and am an Independent student:
Independent students: please indicate the level of YOUR TAXABLE INCOME for 2025 (see IRS 1040 line 15)
Dependent students: please indicate the level of YOUR TOTAL FAMILY TAXABLE INCOME for 2025 (see IRS 1040 line 15)
How many people are supported by this household income?
Student Signature
Name

First NameLast Name
Date Signed

MonthDayYear
mm-dd-yyyy
Parent Signature (if student is a Dependent Student as determined by the FAFSA Dependency Questions)
Name

First NameLast Name
Date Signed

MonthDayYear
mm-dd-yyyy

My enrollment in the Student Support Services (SSS) STEM program represents my commitment to my academic success. This means that I agree to the following:

I UNDERSTAND that my academic performance will be monitored until I exit Columbus State Community College so my advisors have the information they need to help me be successful

I UNDERSTAND that SSS STEM staff will access my financial aid account and records in the Department of Financial Aid in order to track the status of my financial aid application so they can help me complete all the necessary forms to help me get the aid I need to fund my education.

I UNDERSTAND that SSS STEM is a part of the Starfish/Early Alert System and all flags and Kudos raised by my instructors are shared with the TRIO/SSS team. My SSS STEM coach will follow up with all flags that are raised so they can connect me with the services necessary to complete my courses successfully. They will also contact me to congratulate me on all Kudos.

I AGREE to complete the following minimum requirements which include:

· Meet with my Student Support Services STEM advisor at least three times each semester to set goals, develop an individual academic plan, and evaluate progress and goal accomplishments.

· Participate in TRIO SSS STEM program activities that are designed to help me succeed and engage with the TRIO SSS STEM staff and peers to build a strong success network.

· Check my CSCC email regularly

· Attend workshop, campus visits and other activities that are relevant to my degree plan, transfer plans and overall success

I UNDERSTAND that completing 30 semester hours per year increases the likelihood that I will graduate. This can be accomplished in 2 full time or 3 part time semesters. I will work with my TRIO advisor to determine the best plan for my success.

I UNDERSTAND that the Student Support Services STEM plan is voluntary and that there are three ways that I can leave the program:

· I can notify the TRIO SSS STEM staff that I no longer wish to participate in the program and I will be removed from the program and will no longer be eligible for the services that are offered

· If I stop taking courses at CSCC, graduate or transfer from CSCC I will be removed from the program at the end of the academic year

I UNDERSTAND that I can count on my TRIO/SSS STEM advisor to help me meet my academic goals.

I have read and received a copy of this document and agree to abide by the program rules and requirements as stated above in order to continue enrollment in the Columbus State Community College Student Support Services program.
I understand that TRIO SSS has limited enrollment and that participation requires an
active commitment. If accepted, I agree to meet regularly with my Academic Coach (in person and by email) and use available SSS services to help me reach my academic goals.
Participant Name

First NameLast Name
Participant Cougar ID Number
Participant's Signature
Name

First NameLast Name
Date Signed

MonthDayYear
mm-dd-yyyy