Southeastern Community College

TRIO Student Support Services Application


Personal Information

First Name:

Middle Name: If no legal middle name, please enter 'x'

Last Name:

Birth Date: in MMDDYYYY format

Social Security Number:

P.O. Box: if applicable

Full Street Address: if applicable



Zip Code:

Phone Number: Please include your area code.

Secondary Phone Number: Please include your area code.

Start Date At SCC: in MMDDYYYY format

E-mail Address:


Are you planning on transferring to a 4-year school? Yes   No

Have you applied for FAFSA? Yes   No

Have you taken COMPASS? Yes   No

Dependent Status

Are you over the age of 24? Yes   No

Are you? Single   Married   Divorced   Widowed

Have you ever served in the military? Yes   No

If you answered "No" to all questions above, you are considered a dependent student. if you answered "Yes" to at least one question, you are considered an independent student.


Are you a United States citizen or permanent resident?   Yes   No

Are you a first generation college student (neither parent has a 4 year degree)?   Yes   No

Do you have a documented disability?   Yes   No

Dependent Students - please answer the following

How many people live in your custodial parent's household that they are financially responsible for? (if you do not live at home with your parents, add yourself into the household number)

What are your parents last year's taxable income?

Independent Students - please answer the following

How many people live in your household that you are financially responsible for?

What is your last year's taxable income?

Taxable income can be found on the following lines of your tax form: 1040 (Line 43) - 1040A (Line 27)  - 1040EZ (Line 6)


Gender: Male   Female   No Response


Which race are you? (select one or more)
     American/Alaska Native
     Asian/Pacific Islander
     Black or African American
     Hawaiian/Pacific Islander

Educational Background

Do you have a: High School Diploma  or GED   Date Received

Please check the services you are most interested in receiving from the TRIO SSS program:

Assistance with choosing my classes

Assistance with choosing my transfer school

Assistance with applying for or understanding financial aid

Assistance with my classes

Help with improving my study skills

Assistance choosing a major

In what field would you like to work after graduation?

What do you see yourself doing five years from now?

Please explain briefly why you want to participate in the TRIO Student Support Services program?

How did you find out about the TRIO SSS program?

Will you be an athlete for SCC? Yes   No   If so, which sport?

By clicking "Submit Application", I authorize the SCC TRIO SSS program to obtain, copy, review and discuss records including: high school transcripts, course registration for each semester, transcripts from other colleges, academic progress reports, financial aid records, transcripts and standardized test scores. I understand the college reserves the right to admit or deny any student enrollment in the TRIO SSS program. Completion of the application does not guarantee acceptance into the program. I also certify that all of the above information is correct.