University Of North Carolina-Charlotte-SSS-Application Form

University Of North Carolina-Charlotte-SSS-Application Form
- Name
  
  First NameMiddle NameLast Name
- Preferred Name:
- Student ID
- Date of Birth:
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Gender:
- Ethnicity:
- Are you a U.S. citizen?
- Charlotte Email Address:
  example@example.com
- Personal Email Address:
  example@example.com
- Cell Phone Number
  (999)999-9999
- Permanent Phone:
  (999)999-9999
- Permanent Home Address:
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Local or Campus Address:
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Preferred Contact Method:
- Current Classification
- Major
- Double Major (if applicable)
- Minor (if applicable):
- From which high school did you graduate?
- High School GPA
- Are you a transfer student?
- From which institution are you transferring?
- Transfer GPA:
- What year do you plan on graduating from UNC Charlotte?
- Do you already have a college degree?
- If you have already completed a college degree, what type of degree did you earn?
- Are you involved with any programs, organizations or groups on campus?
- List your campus affiliations:
- What areas would you like TRIO SSS to support you with? Select all that apply. Your responses will help us understand your goals and connect you with appropriate services and resources.
- Academic Support
- Study Skills
- Educational Planning
- Career Planning
- Graduate/Professional School
- Financial
- Social/Personal
- Have either of your parents (biological or adoptive) earned a bachelor's (4-year)degree?
- Did your MOTHER graduate from college with a 4-year degree?
- Did your FATHER graduate from college with a 4-year degree?
- If YES to either, with which parent do/did you live?
- Have you ever been diagnosed with, or do you believe you may have, a learning,attention, or accessibility-related challenge that has affected your academic experience?
- Are you registered with the Office of Accessibility and Accommodation at UNCCharlotte? (formerly known as the Office of Disability Services)
- For financial aid purposes, are you considered a dependent or independent student?
- Number of people living in your household (including yourself)?
- Please complete the information below, which verifies your family income for the lastyear. *Taxable Income*: This information can be found on Line 15 of yours or yourparent’s 1040 form. DO NOT USE YOUR ADJUSTED GROSS INCOME (AGI) *DEPENDENT STUDENTS: If under 24 years of age, single, have no children or childrenreceiving less than half of their support from you, provide your PARENT'S TAXABLE ANNUALINCOME from the most recent tax return.INDEPENDENT STUDENTS: If 24 years of age or older, married, a veteran or active-dutymilitary member, have children who receive more than half of their support from you, or are anorphan or ward of the court, provide YOUR taxable annual income from the most recent taxreturn.What is your family's taxable income for last year? (not to include non-taxable income such asSSI, VA Disability, Child Support, TANF, etc.)
- Certification
  As evidence of my signature below, I hereby certify that all the information I have provided is
  correct and true to the best of my knowledge.
- Student Signature
- Date Signed
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Parent Signature (for dependent students under the age of 24)
- Date Signed
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Are you receiving Financial Aid at UNC Charlotte?
- Do you receive the PELL Grant?
- Directions to access and upload your FAFSA Submission Summary:
  a. Access: https://studentaid.gov/
  b. Log into your StudentAid.gov account Dashboard.
  c. Select your processed FAFSA Summary Submission Form under My Activity
  section.
  d. Select “View FAFSA Submission Summary for current academic year.
  e. Scroll up to the top of the page and click on Print FAFSA Submission Summary.
  f. A new window will open -- Choose Save as PDF.
  
  A complete report is required in PDF format. Snapshots are not accepted.
- Upload PDF:
  
  Cancelof
- ACKNOWLEDGEMENT
  I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that TRIO Student Support Services may request additional documentation when necessary to verify my eligibility for the program.
  I authorize UNC Charlotte TRIO Student Support Services (SSS) to access, request, receive, and use information related to my enrollment, academic progress, financial aid, and educational records as necessary to determine and document my eligibility, provide appropriate TRIO SSS services, monitor my academic progress, and meet applicable federal program reporting requirements.
  I understand that this may include information such as enrollment status, grade point average, earned credits, academic standing, degree progress and completion, financial aid information, and other educational information relevant to my participation in TRIO SSS.
  I understand that information collected by TRIO SSS will be maintained in accordance with applicable University policies and federal privacy requirements. I agree to provide additional information or documentation when reasonably requested to maintain an accurate TRIO SSS participant record.
- Required Signature
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate