Application for TRiO: SSS | Hagerstown Community College

Citizenship/Residency Verification

Are you a citizen or permanent resident of the United States?: *

Yes

Select what number you would like to use for verification: *

Enter number here: *

First Generation Verification

Has your mother received/earned a four-year college degree? : *

Yes

Has your father received/earned a four-year college degree? : *

Yes

With which parent did you regularly reside and receive support from during your childhood?: *

Mother

Father

Both Mother and Father

Neither Mother nor Father

Until you were 18 years old.

Income Verification

Applicants are required to provide one of the following:

A signed statement regarding income from student (independent)

A signed statement from the individual's parent or legal guardian (dependent)

Verification of family income from another governmental source

A signed financial aid application

A signed U.S./Puerto Rico tax return

Check at least one

Students With Disabilities Information

Do you have a documented physical, emotional, and/or learning disability? : *

Yes

Do you receive accommodation through HCC Disability Support Services (DSS)? : *

Yes

Disability information will be verified with Hagerstown Community College's Office of Disability Support Services.

Academic Information

What is your program of study (major) at Hagerstown Community College? : *

Have you ever received a college degree?: *

Yes

Are you planning to transfer to a four-year institution?: *

Yes

Undecided

Do you plan to receive a certificate from Hagerstown Community College?: *

Yes

Do you plan to complete a degree at Hagerstown Community College?: *

Yes

All applicants must have an academic need that will be verified by program staff.

Release of Information

This application is a supplement to the required Hagerstown Community College application and in no way replaces the Hagerstown Community College application.

I certify that the information in this application is complete and accurate. It is also my understanding that the TRiO:SSS staff may exchange academic and financial information with HCC personnel to insure my academic success.

I understand that preference is given to full-time, degree seeking students.

I understand that I am responsible for adhering to all policies and procedures listed in the current Hagerstown Community College Catalog and Student Handbook.

I authorize TRiO Student Support Services to gather information concerning my academic progress (standardized test scores, grade point average, earned credits, transcripts, demographic and ethnicity information) and financial status prior to my participation in TRiO: SSS. I understand this information is used to assist in the determination of my eligibility for Student Support Services, and it will be strictly confidential. I grant permission for TRiO: SSS to gather information for follow-up whenever appropriate, including transfer and progress at four-year institutions. I am aware that my eligibility and financial status will be reported to the U.S Department of Education in accordance with the grant funding regulations. I certify that the information provided on the application is true and complete to the best of my knowledge. I also agree to provide documentation upon request to verify the information reported.

I am also aware that the personal information that is provided to the TRiO: SSS program will be protected under the Family Education Rights and Privacy Act of 1974. No one will have access to the information unless they work with or for the TRiO: SSS program, or are specifically authorized by the student in question to see the information.

Release signature: *

I agree with the above statements.