TRIO SSS Classic | TRIO SSS STEM
PY19/20 Application
5401 West 20
th
Street, Greeley, CO 80632 | College Center 220 970-339-6372 https://www.aims.edu/student/trio
Please return completed application to the TRIO SSS office in College Center 220. Incomplete applications will not be processed! Applications take a
minimum of two weeks to process. Once eligibility is determined a letter will be sent to your Aims email. If you have any questions, please contact the
TRIO SSS office at 970-378-3627 or e-mail Amber.Quinn@aims.edu
. Please print in ink!
Date: ____________________________ Aims #:A00_____________________________________
Name: _________________________________________________________________________________________________________________
Last First M.I.
Address: _______________________________________________________________________________________________________________
Street City State Zip
Home Phone: _____________________________________ Cell Phone: _____________________________________________
Aims E-mail: ____________________________@aims.edu Future Career Title: _____________________________________
Date of Birth: ___________________________ Gender: Male Female
Education: High School Diploma GED Graduation Date: ________________________________________
How were you referred to TRIO SSS? Education Opportunity Center (EOC) Upward Bound (UB)
Educational Talent Search (TS) Student Support Services (SSS) Gear-Up
Avid Other: _______________________________________________________________________________________________
ELIGIBILITY
*If you identify as an undocumented immigrant, you do not meet eligibility requirements for TRIO SSS, however, we would like to refer you to the
Aims Center for Diversity and Inclusion (CDE), Ed Beaty, Rm. 127 for additional resources.
What is your citizenship status? : US Citizen US Permanent Resident
Did either of your parents, or legal guardians, complete a Bachelor’s Degree Yes No
Do you have a documented disability? Yes No
If yes, have you submitted documentation to the Disability Access Center? Yes No
Have you obtained a previous degree/certificate from any College/University? Yes No
Institution: ________________________________________________________
RACE & ETHNICITY
Are you Hispanic/Latino? Yes No
Race (Must check one) American Indian/Alaskan Native Asian Black or African American
Native Hawaiian/Pacific Islander White
INCOME VERIFICATION
If your status is Independent, answer the following income questions about yourself and your dependents. If your status is Dependent, your parents
must answer the following questions about themselves and their dependents. Please select only ONE option.
I am an independent. (1) I am married or (2) I am 24 or older by December 31 of 2019 or (3) have served in the military or (4) I have a child
that I support more than 50% of the time or (5) I was in Foster Care at the age of 13 or older.
I am a dependent. (1) I am not a parent, and (2) I am not married, and (3) I am under the age of 24, and (4) I have not served in the military
Did you and/or your parents file income taxes last year? Yes No
Number of people in your household (please include yourself):___________________
Taxable Income (not adjusted gross income or “annual salary”): ____________________
Depending on which tax form was filed, you will find the amount of your taxable income on: 1040-line 10.
Dependent Students Only
Parent or Legal Guardian Signature: ___________________________________________ Date: __________________________________
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signature
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