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TRIO Student Support Services New Student Access Form 2023-2024
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Email *
ctcLink number *
Social Security Number *
Your Name *
Birth Date: *
MM
/
DD
/
YYYY
Personal Email *
Address *
 Street City   State Zip Code
Cell Phone Number *
Ok to text? *
Alternate Phone Number
Do you give us permission to send you text messages?
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Emergency Contact: *
Name (First and Last) and Phone Number
Gender *
Preferred Pronoun/s *
Marital Status *
Are you a U.S. citizen? *
 Are you a Permanent Resident? *
Are you a Refugee? *
If you are a permanent resident or a refugee what is your registration number?
What is your first language? *
What is/are the ethnic/racial group(s) with which you identify?   *
Check all that apply
Required
Are you an active military member? *
Are you a U.S. veteran? *
Are you a former foster youth or homeless youth after the age of 13? *
Are you a High School graduate or did you complete a GED or High School completion program?   *
Have you completed a Free Application for Federal Student Aid (FAFSA)?  *
Are you receiving Financial Aid?   *
If you are not receiving Financial Aid how are you paying for your classes?
Amount of your or your parent/s TAXABLE INCOME on your or your parent/s 2021 tax return? *
IRS  (2021) – TAXABLE INCOME  can be found on the federal income tax return, IRS forms 1040, 1040A, and 1040EZ.   You must add your 2021 taxable income and your parents’ together to determine eligibility.  If your parents are married you must include both of their incomes.  If they are legally separated or divorced, include the income of the parent you lived with most in 2021.
Were you claimed as a dependent on your parents 2021 tax return? *
What is the size of your family unit in 2021? (All individuals, including yourself, that live in your household). You are considered a dependent if (you are under the age of 24 and not married), you will need to provide your parent/s tax information if you are a dependent.
Do you have a degree from a U.S. 4-year college or university? *
Did your FATHER/guardian graduate from a 4-year college or university? *
Did your MOTHER/guardian graduate from a 4-year college or university? *
Do you have a disability? *
Are you registered with Services for Students with Disabilities (SSD) at Edmonds College? *
Is attending Edmonds College your FIRST college experience? *
If no, what other colleges have you attended, including dates?
Please include all, even if you only completed one course
What degree(s) are you pursuing at Edmonds Community College? *
Degree Title *
Expected Graduation Date (mm/yyyy) *
Do you plan to transfer to a 4-year college or university? *
If Yes, what is your intended major?
If Yes, what is your intended 4-year college or university?
Are you planning to also complete any certificate or certificate of completion (COC) programs while working towards your associate degree? *
How can TRIO Student Support Services best support your educational goals?  Please check all that apply: *
Required
Affidavit of Truth Statement and Release of Information. *
The information provided on this form is, to the best of my knowledge, accurate and true.  I understand that by applying to the TRIO SSS program, I authorize program staff to obtain records or data pertinent to my participation from other campus offices and/or public agencies such as financial aid and academic records, and I authorize program staff to release information to the U.S. Department of Education for reporting purposes. I understand that I am not eligible to receive TRIO SSS program services until the application and interview process is complete.
Type out your full legal first and last name to use as your signature. *
By signing below, I grant permission to TRIO Student Support Services to track all of my academic progress at Edmonds College. *
Type out your full legal first and last name to use as your signature.
By signing below,  I authorize the release of my student academic and financial aid records for the program staff to use for reporting purposes to the Department of Education. *
Type out your full legal first and last name to use as your signature.
What are your academic/educational goals at Edmonds College? *
What are a few of the barriers you are facing that may prevent you from reaching your educational goals? *
Why are you interested in joining TRIO Student Support Services? *
How did you find out about TRIO? *
Do you have an academic plan?
If you have an academic plan please email it to trio@edmonds.edu
 *
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