FAMU TRiO Student Support Services

2017-2018 Application

The TRiO Student Support Services (SSS) is funded by the U.S. Department of Education and Florida
Agricultural and Mechanical University (FAMU). The FAMU TRiO SSS program annually provides individual
and group services to 250 students so that they develop the skills and motivation necessary to achieve a
bachelors degree.

TRiO SSS serves all program participants regardless of race, color, creed, religion, national or ethnic origin,
gender, sexual orientation, disability, marital status, or age.

TRiO/SSS is not a scholarship program! However, a limited number of active participants may qualify and
receive a program-based scholarship contingent on annual funding.

Students participate in TRiO SSS throughout their enrollment at FAMU. It is expected that program
participants meet with their TRiO/SSS advisor or engage in other activities at least once per month.

Program Eligibility
FAMU TRiO SSS participants must be U. S. citizens or permanent residents or refugees pursuing their
first bachelors degree. Participants must be incoming or currently enrolled FAMU college students.
Program participants must demonstrate academic need for services and meet at least one of the following
criteria:

Low-income student: a student whose family meets federal income eligibility guidelines as
verified by FAMU

First generation college student: a student where neither (custodial) parent has received a
bachelors degree or a student who did not regularly live with or receive support from a
(custodial) parent

College student with documented disabilities: as defined in the American with Disabilities
Act (ADA) and verified by the Center for Disability Access and Resources (CEDAR)

Selection Process
When there is limited space in the TRiO/SSS program, priority will be given to:

Alumni of other TRiO programs: Upward Bound, (Educational) Talent Search, Educational
Opportunity Center, or other Student Support Services programs

Students who are both income-eligible and first generation college students

Students who are both income-eligible and have disabilities that require educational
accommodation

Student who are motivated to take full advantage of services offered through the TRiO SSS
program

PLEASE TYPE OR PRINT INFORMATION AND SEND TO:

TRIO/Student Support Services

640 Gamble Street, Tallahassee, FL 32307-5800
Phone: (850) 561-2104 Fax: (850) 599-3745
Website: http://www.famu.edu/trio
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 FAMU TRiO Student Support Services
2017-2018 Application
DEMOGRAPHIC INFORMATION
Name:
Date of birth: SSN: Student ID:
Current address:
City: State: Zip Code:
Cell Phone: Home Phone:
Gender: Male Female College Transfer Student: Yes No
School E-mail Address: Personal Email Address:
Have you ever participated in any of the following Programs? If so, please select which one(s): Where: ___________________

Upward Bound Educational Talent Search CROP GEAR UP Student Support Service (Community College)
Are you a homeless or foster care student? Yes No If check Yes, documentation will be required
ETHNICITY/RACE INFORMATION
Racial Category (Check all that apply): Race/Ethnicity Descriptions as defined by the U.S. Dept of Education
American Indian or Alaskan A person having origins in any of the original peoples of North and South American (including
Native Central America), and who maintains tribal affiliation or community attachment.

Asian A person having origins in any of the original peoples of the Far East, Southeast Asia, or Indian
subcontinent, including Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, Philippine Islands,
Thailand, and Vietnam.
Black or African American A person having origins in any of the black racial groups of Africa.

Hispanic or Latino Refers to a person of Cuban, Mexican, Puerto Rican, South or Central American, or Spanish culture
or origin.
Native Hawaiian or Other Pacific A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific
Islander Islands.

White A person having origins any in any of the originals of peoples of Europe, the Middle East, or North
Africa.
More than one ethnic group If you are more than one ethnic group, check all boxes that apply.

Other (please specify):

________________________
ELIGIBILITY INFORMATION
Citizenship Status: U.S. Citizen
Permanent Resident (non-U.S. citizen with permanent residence status)
1st Generation Information
Educational attainment of mother or female guardian (living in household only):
High School Some College Bachelor Master Specialist Ph.D.

Educational attainment of father or male guardian (living in household only):

High School Some College Bachelor Master Specialist Ph.D.

Income Verification
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 FAMU TRiO Student Support Services
2017-2018 Application
Dependent Student- Claimed by parent(s) or other person(s)
Financial Aid Status: Independent Student- 25 year old or older or married, a veteran or active military, have children who
receive more than half of their support from you, if you are an orphan or ward/dependent of the court.
For purposes of documentation, please provide a copy of your parent(s) or guardian(s) most recent Federal Income
Tax Return (2016). Make sure that it contains the names of your dependents and the Taxable Income for 2016.

Did your parent(s)/guardian(s), or are your parent(s)/guardian(s) planning Yes

to file a federal income tax return for 2016?
No
If yes, what was the 2016 taxable IRS FORM 1040 (line 43) $
income?
(Check which form was used and IRS FORM 1040-A (line 27) $
fill-in the taxable income.)
IRS FORM 1040EZ (line 6) $

Temporary Aid to Needy Families (TANF)

Food Stamps
Veteran Benefits
Please select which source of assistance you family
receives: Social Security
Retirement Benefits
Unemployment Benefits
Other
How many people are in your household?
PARENT/GUARDIAN AGREEMENT
I hereby certify that all information provided in this application to the TRiO Student Support Services Program is complete, correct and true to the best
of my knowledge. I understand that the information provided will be used to determine eligibility, is subject to external verification by the U.S.
Department of Education and may be released to that entity only for such purposes. I also agree to attend workshops, tutoring sessions, meetings and
other events as requested by the program to remain active in the program. I also agree to allow SSS to use photos for recruitment and media
opportunities.

Student Signature Date

My signature below indicates that my child is under18 years of age and that the information given on this application is true and complete to the best of
my knowledge.

Parent Signature Date

DO NOT WRITE BELOW THIS SPACE

Date Received: Eligibility: LI FG DS DS/LI
LI/FG
Date Accepted: Staff Initial:
Program Referral: Selection Criteria Score Classification: