PROGRAM YEAR 2024-2025

TRiO Student Support Services is a federally funded program through the U.S. Department of Education. To determine your qualifications for this program, please complete this application in its entirety. The information you provide is strictly confidential. Only completed applications will be accepted and does not guarantee admission to the program. For more information, you may contact us at 671-735-2248/58.

Before submitting your application to the program, make sure you have the following:

• Current class schedule
• Verification of Disability (if applicable)
• Signed copy of most recent Federal Income Tax Return/Form
• Valid passport or birth certificate

**This application cannot be saved.**

DEMOGRAPHIC INFORMATION

11.) Race/Ethnicity:

ACADEMIC INFORMATION

PROGRAM ELIGIBILITY

Dependent/Independent Status:

26.) The federal government uses the following criteria to determine INDEPENDENT student status. Please check all that apply to you:

If you DID NOT CHECK any of the above, you are considered a DEPENDENT student and MUST submit your parent’s or legal guardian’s latest signed Federal Income Tax Return/Form. Otherwise, you are considered INDEPENDENT and MUST submit your latest signed Federal Income Tax Return/Form.

Financial Information:

TAXABLE INCOME: It is very important that you indicate TAXABLE INCOME, not the total income or adjusted gross income. Taxable income is reported on: Form 1040 U.S. Individual Income Tax Return, line 10.

If you are not able to provide a signed Federal Income Tax Return/Form, provide one of the following:

1. A signed copy of your 2022-2023 Student Aid Report (SAR)
2. Verification of monthly benefits from appropriate agency
3. Signed statement from parent or legal guardian stating yearly income, source of income and current number in household.

FAMILY SIZE: This is the number of exemptions claimed on the Federal Income Tax Return/Form, including your parents, yourself, siblings and any other person reported on the form. If you are independent, include yourself, spouse, children and any other person supported by you.

For family units with more than eight members, add the following amount for each additional family member: $7,710 for the 48 contiguous states, the District of Columbia and outlying jurisdictions; $9,645 for Alaska; and $8,865 for Hawaii.

The term "low-income individual" means an individual whose family's taxable income for the preceding year did not exceed 150 percent of the poverty level amount.

The figures shown under family income represent amounts equal to 150 percent of the family income levels established by the Census Bureau for determining poverty status. The poverty guidelines were published by the U.S. Department of Health and Human Services in the Federal Register on January 19, 2023 and are effective as of January 19, 2023.

RELEASE OF INFORMATION/MEDIA

PRIVACY ACT INFORMATION:

In accordance with the Privacy Act of 1974 (Public Law No. 93-579, 5 U.S.C. 552a), you are hereby notified that the Department of Education is authorized to collect information to implement the Student Support Services Program under Title IV of the Higher Education Act of 1965, as amended (Pub. Law 102-325, Sec. 402D). In accordance with this authority, the Department receives and maintains personal information on participants in the Student Support Services program. The principal purpose for collecting this information is to administer the program, including tracking and evaluating participant progress. The information that is collected on this form will be retained in the program files and may be released to U.S. Department of Education officials in the performance of their official duties as defined by federal law.

RELEASE OF INFORMATION/MEDIA:

By signing this document, I grant permission to University of Guam TRiO Student Support Services (SSS) to track all my academic progress at UOG. I hereby authorize the release of my student academic and financial aid records for the SSS professional staff to use to discuss with me and if appropriate my instructor in order to better assess my academic progress. Such records include, placement test scores, academic records/progress reports, course grades, transcript, GPA, demographic information, and financial aid status/award. I understand that my instructors may be contacted during the semester to evaluate my class progress. These evaluations will be available to me upon request. I understand that this information is used to assist in the determination of my academic need, eligibility for the program, academic progress while attending UOG and tracking after leaving the program. I understand the information obtained will be kept strictly confidential. I grant permission for UOG TRiO SSS to obtain information for follow-up whenever appropriate.

In addition, I hereby give my permission for release of my data, photograph, work and/or statements to be used by UOG TRiO SSS for award recognition, reporting, promotional, or publicity purposes. 

I am aware that my information will be reported to the U.S. Department of Education in accordance with the grant funding regulations. 

If found eligible for UOG TRiO SSS, I agree to actively participate in the program, and I certify that the information I provided in this application is correct to the best of my knowledge. 

I understand that completing this application does not guarantee my admission to the UOG TRiO SSS Program.

NEEDS ASSESSMENT SURVEY

4.) The following areas is what I would NEED assistance in:

Academic:

REQUIRED DOCUMENTS