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TRIO / Student Support Services

Application For Services

 

Contact Information:
* First Name:
* Last Name:
MI:
* S#:
* Address:
* City:
* State:
* Zip:
* Your e-mail address:
* Preferred Phone:
* Home Phone:
* Cell Phone:

Permanent Contact:
* First Name:
* Last Name:
MI:
* Address:
* City:
* State:
* Zip:
* Phone:
* Relationship:

* Citizenship:
A#:
Other:
First Generation:
* Has your mother (legal guardian serving in the role of mother) received/earned a 4-year college/university degree?
* Has your father (legal guardian serving in the role of father) received/earned a 4-year college/university degree?

Dependency Status: All students applying for TRIO/Student Support Services must submit income verification.

Answer the questions below:

* As of today are you 24 years of age or older?
* Are you married?
* Do you have children who will receive more than half of their support from you during the current academic year?
* Do you have dependents (other than your children or spouse) who receive more than half of their support from you?
* 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?
* Prior to reaching 18 years of age, were you an emancipated minor or have a court appointed legal guardian?
* Are you currently serving on active duty in the U.S. Armed Forces for purposes other than training?
* Are you a US Armed Forces veteran who was on active duty and released under conditions other than dishonorable conduct?
* Have you previously earned an Associate or Bachelor degree?
* Are you less than 18 years of age and have no parent or guardian?
* Are you homeless (i.e., you lack a fixed, regular and adequate nighttime residence) or at risk of becoming homeless?

After answering the questions, check the box that applies:

If you answer NO to every question, you are a DEPENDENT student. Bring in a signed copy of your parent's U.S. (federal) tax return for last year.
If you answer YES to ANY question, you are an INDEPENDENT student. Bring in a signed copy of your U.S. (federal) tax return for last year.

If you or your parents did not file taxes, discuss alternative forms of income verification with a TRIO/SSS Advisor.

 

*  Are you a Dependent or an Independent student?
* What income verification documentation will you submit?:

Academic Plan:
* What year did you first start college?:
* Where?:
* What degree are you working toward?:
* What is your intended program of study?:
* Are you planning on completing a degree from SLCC?:
* Are you planning on transferring to a 4-year school?:
If you are planning on transferring to a 4-year school, where do you plan to transfer?:
* Who referred you to the TRIO Program?:
* If you are not currently enrolled at SLCC when do you plan on attending?:
* Have you participated in a TRIO program (Talent Search, Upward Bound, Student Support Services, etc.)?:
If yes, where?:

The following information is for federal reporting purposes only and must be completed.
It does not determine your eligibility for the program. If you have questions, please ask us.

* Gender:
* Ethnicity: Are you Hispanic / Latino?
* Race: (Select 1 or more)

* Date of Birth (mm/dd/yyyy):
* Marital Status:
# of Children:
Age(s):

 

Salt Lake Community College

4600 South Redwood Road Salt Lake City, UT 84123
801-957-7522
TRIO / Student Support Services hours: M - F : 8:30am -4:30pm
Contact: 801-957-4089 | SSS.Trio@slcc.edu