Redlands Community College
TRIO STUDENT SUPPORT SERVICES
Student Support Services – A Federal TRiO Program
1. Are you a U.S. Citizen? Yes_____; No____ Type of Verification: ___________________________________
2. Are you applying for Financial Aid (FAFSA)? Yes____; No____
a. If YES to question 2, will you be eligible for a Pell Grant? Yes____; No____
b. If YES to question 2, were you required to put your parent(s) information on the FAFSA? Yes____; No____
If you answered YES, how many people are in your parent or parents’ household (including you)? ________
(Please, submit copies of your parent’s most recent income taxes)
If you answered NO, how many people are in your household (including you)? _______
(Please, submit copies of your most recent income taxes)
3. Did EITHER of your parents graduate from a 4-year college/university? Yes_____; No_____
a. If YES, from what school? ___________________________________________________
4. Have you participated in: (Check ALL that apply)
_____Upward Bound; _____ Upward Bound Math & Science; _ ____Veterans Upward Bound
_____Talent Search; ______Educational Opportunity Center; _____Student Support Services
5. Do you have any professionally diagnosed physical or learning accommodation needs? ____Yes; ____No
a. If YES, briefly explain: ____________________________________________________________________
6. Do you plan to transfer to another school? ____Yes; ____No If yes, which one(s)? ______________________
7. Are you currently in:
Foster Care ___Yes; ___No
Homeless ___Yes; ___No
Project AIMS
Name: _________________________________________ Student ID#:________________________________
Last First MI
Sex: M____ F____ Birth Date: _____/_____/_____ Social Security #:___________________(Required)
Mailing Address: ____________________________________________________________________________
Number/Street/Apt # City State Zip
Home Address:______________________________________________________________________________
Home Phone#: (_______)_________-_________ Cell Phone (______)_____-_____________
Home Email: _______________________________School Email______________________________________
X the appropriate category: White non-Hispanic____; American Indian or Alaskan Native____;
Black non-Hispanic____; Hispanic____; Asian or Pacific Islander____; Other_________
Asian or Pacific Islander; Hispanic; Other____________
OFFICE USE ONLY
DEGREE ___________
FLAG ____________
PARTICIPANT CERTIFICATION AND CONTRACT AGREEMENT
I CERTIFY that the information I HAVE provided in applying to Trio Student Support Services is true and correct to the best of
my knowledge. I GIVE Trio SSS my permission to receive copies of my educational records and other materials necessary for
participation in the Trio SSS in accordance with the Privacy Act of 1974, all my records will be kept in confidence. I also give
permission to have any photos taken used for Trio SSS Web site, recruiting materials, and other project related activities. I
ACKNOWLEDGE that I HAVE discussed the ACADEMIC PLAN OF ACTION with Trio SSS Staff and I REALIZE that it is subject to
revision. I HAVE RECEIVED information on financial aid and I WILL PARTICIPATE in recommended Project services and activities
that will support increased success in college and improve my transferability. I AGREE to make regular contact with a Trio SSS
Staff Person.
________________________________________ ____________________________________
PARTICIPANT SIGNATURE DATE
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