SUNY Schenectady County Community
College TRIO Student Support Services
General Information:
First Name: ____________________ MI: ____ Last Name: _______________________
SUNY Schenectady Student ID Number: 900_______________________
Name (if any):
Current mailing address:
City, State, Zip:
Best phone number to reach me:
_____________________ Is this a cell number?____ Yes
____ No
s it permitted to text your cell? Yes No Carrier/Service Provider: __________________
Date of Birth: ________________
Gender: _________________________________
*Gender is used by the TRIO office to prepare summary data reports to the Federal and other government agencies. It will not be used
in any way to determine your acceptance into TRIO Student Support Services.
Eligibility Information: Students are eligible to apply for TRIO Student Support Services at SUNY
Schenectady if they meet the following U.S. Department of Education guidelines.
Please check all that apply to you:
I am accepted to SUNY Schenectady and enrolled in classes(currently or for next semester)
I am enrolled in six (6) or more credits at SUNY Schenectady this semester
3. I am permitted to apply for Federal financial aid as a United States citizen or eligible
I have not yet earned a Bachelor's degree.
5. I am in need of academic support.
6. And meet at least one of the following criteria:
The parent(s)/legal guardian(s) that you regularly resided with prior to age 18
have not graduated with a Bachelor’s degree (4-year degree).
b. I meet government income guidelines based on the chart (at end of application)
I have a documented physical, medical, psychological, or learning disability that
is registered with the SUNY Schenectady ADA Transition Services Office.
Academic Information
Intended Major(s): __________________________ What semester are you in? _________________
How many college credits have you completed? 0-12 13-24 25-36 37-55 55+
Are you currently on academic probation at SUNY Schenectady? Yes No
Have you previously been on academic probation at SUNY Schenectady? Yes No
Please check off classes you are currently enrolled in and/or may need academic support:
____ Math 085 ____ Math 095 _____ Math 086 _____ ENG 096
Other Information:
Are you planning to graduate with an Associate’s Degree or certificate from SUNY Schenectady?
Please choose an answer: Yes No Unsure
Are you looking to transfer to a four (4) year college after graduating from SUNY Schenectady?
Please choose an answer:
No Unsure
Are you cur
rently employed?
_____ N
___ Yes
1-9 hrs/wk 10-19 hrs/wk 20-29 hrs/wk 30-39 hrs/wk 40+hrs/wk
Please mark
one of the following ethnic identities:
__ Hispanic/Latino __ Not Hispanic/Latino
Please choose f
rom one of the following racial identities. You may select more than one:
__ Asian
__ Am
erican Indian or Alaskan Native
__ Native Hawaiian or other Pacific Islander
__ Black or African American
__ White
Have you ea
rned your high school equivalency diploma (GED or TASC) through an alternate program within
the previous five years? ___ YES ___ NO
How did you hear about the TRIO Program (please check all that apply):
Staff Member
presented in your class
__ Admitted Student Day
__ TRIO staff member at a
__ Flyer/poster posted on
__ Professor/Instructor
__ Postcard in mail
__ College staff member
_ Bulletin Board
__ Disability Services Center
__ TV screens on campus
__ RA (Resident Assistant)
__ TRIO SSS banner on
Frie nd
__ Table tent (flyer on table)
__ Parent/G
__ Email
__ Campus Visit Day
__ Website
__ Admission Open House
__ Other. Please share:
I hereby apply for services in the TRIO Student Support Services (SSS) program at SUNY Schenectady County
Community College (SUNY Schenectady). I certify that the information I have supplied on this form is true and accurate,
to the best of my knowledge. I understand that the TRIO program can share and receive information from my educational
benefit with other SUNY Schenectady offices, staff and faculty according to the Family Rights and Educational Privacy
Act (FERPA) of 1974. I understand that my application does not indicate automatic acceptance into the program. I
understand that I may withdraw from this program at any time.
Student Signature:____________________________________ Date: ___________________
Please submit this application to the following campus location:
TRIO SSS Program Office
SUNY Schenectady County Community College
78 Washington Avenue
Elston Hall Room 328
Schenectady, NY 12305
You may
also email us at
Or visit our website: for
additional information.
Equal Opportunity Policy. In complying with the letter and spirit of applicable laws and pursuing its own goals of diversity, Schenectady
County Community College shall not discriminate on the grounds of race, color, religion, sexual orientation, inkling transgender status
or expression, national origin, citizen status, age, disability, or veteran’s status in employment, education and all other areas of the
SUNY system. The college provides reasonable accommodations to qualified individuals with disabilities upon request.
Questions and complaints about discrimination in any are of the college should be directed to the campus Equal Opportunity Director.
For contact information please visit
*TRIO is a federally funded, five year grant program through the U.S. Department of Education at SUNY Schenectady with an annual
budget of $281,511 that works with 175 eligible students*
click to sign
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Federal TRIO Programs
Current-Year Income Levels
(Effective January 18, 2018 until further notice)
Size of Family Unit
48 Contiguous States, D.C., and Outlying Jurisdictions
For family units with more than eight members, add the following amount for each additional family member:
$6,480 for the 48 contiguous states, the District of Columbia and outlying jurisdictions; $8,100 for Alaska; and
$7,455 for Hawaii.
How do I read the federal income chart?
If you have 3 people in your household and your taxable income was $15,625, then your income would fall
below the cut off of $31,170 for the 48 contiguous states. You would then be income eligible to apply to TRIO
Student Support Services.
What i
s considered family unit?
Family unit is defined as the total number of persons who are related to you by blood, marriage or adoption
and are dependent on the head of household for support. A stepparent or stepchild in considered related by
Where do I find my taxable income information?
You can use your most recent federal income taxes.
IRS Form 1040 Line 43
IRS Form 1040A Line 27
IRS Form 1040EZ Line 06
*The parents’/legal guardians’ federal tax return must be used if they claimed the student as a dependent on their 2017
income tax return, or if the student was under 24 years old, single and not a veteran. The student’s federal tax return must
be used if the student was not claimed as a dependent and was 24 or older, or is a veteran, or was married (spouse’s
2017 income should be included).