TRiO Student Support Services

Program Application

DEPENDENT students will need a parent's or guardian's signature for the Financial Section of this application. (A dependent student is younger than 24, unmarried or not emancipated, parental income is reported on the FAFSA.) If you are unable to obtain the signature at this time, a TRiO staff member will contact you with further instructions; please continue completing this application.

TRiO Student Support Services (SSS) is a Department of Education grant-funded program committed to increasing the retention, graduation, and transfer rates of its participants. Student scholars in our program are provided with comprehensive support services designed to help them succeed – free of charge! From one-on-one tutoring to exceptional advising support to grant aid, we offer a variety of opportunities to help our student scholars achieve their academic, career, and personal goals.

Eligibility Requirements:

To be eligible for the TRiO SSS program, you must:

be a U.S. citizen or Permanent Resident
have a 2.0 GPA or higher
NOT already have an AA or AS degree
have intentions to earn a four-year bachelor's degree

And meet at least ONE of the following requirements:

Demonstrate financial need (If you are a Pell Grant recipient, then you are probably eligible), OR
Be a first-generation college student (neither one of your parents/guardians has a 4-year degree), OR
Have a documented physical or learning disability

Overview of TRiO SSS Services:

One-on-one academic tutoring
Academic coaching and mentoring
Course selection advice and assistance
Financial/Economic literacy
Transfer advising and 4-year college campus tours
Cultural enrichment trips
Grant aid

Statement of Confidentiality:

The information contained in this application is for the purpose of determining the applicant’s eligibility for the TRiO Student Support Services program. All information received is highly confidential. The applicant must complete the financial income section as required by the guidelines set forth by the U.S. Department of Education. If you have any questions, please contact our office at (386) 506-3634.

SECTION 1: Personal Information

First Name *

Middle Name *

Last Name *

Preferred name

School ID *

Date of Birth *

Gender *

Are you Hispanic? *

Are you American Indian or Alaskan Native? *

Are you Asian? *

Are you Black or African American? *

Are you Hawaiian or other Native to Pacific Island? *

Are you White? *

Marital status *

Current street address; include apartment/building/unit/lot number, if applicable. *

City *

State *

Zip Code *

DSC Email Address *

Personal email address *

10-Digit Cell Phone Number (no spaces or dashes) *

Are you a US citizen or Permanent Resident? *

How did you find out about our program? *

SECTION 2: Eligibility Information

Does your mother have a Bachelor's Degree or higher? *

Does your father have a Bachelor's Degree or higher? *

Were you or are you currently in foster care? *

Are you an emancipated or homeless student? *

Are you a veteran? *

Did you complete the FAFSA? *

Do you already have an AA or AS degree? *

Are you eligible for the Pell Grant? *

SECTION 3: Disability Information

Do you have a documented mental, physical, or learning disability? *

Are you registered with DSC’s Counseling and Accessibility Services (CAS)? *

SECTION 4: Financial Information

A parent must sign for a DEPENDENT student for this Financial Section. Student Support Services is required to provide documentation of a student’s eligibility for the program to the U.S. Department of Education and implement the TRiO regulations that state two-thirds of the students served must meet federal low-income guidelines. Verification requirements vary depending on whether a student is independent or dependent. A list of federal criteria for independent student status is available at www.fafsa.ed.gov. This information will be used only to determine or verify eligibility for the TRiO Student Support Services program. All information is confidential and is never passed on to any other agency. The U.S. Department of Education provides more information about TRiO and eligibility requirements online at www.ed.gov/ope/trio.

Are you a DEPENDENT student? (A dependent student is younger than 24, unmarried or not emancipated, parental income is reported on the FAFSA.) *

Are you an INDEPENDENT student? (An independent student is at least 24 years old, married or emancipated; parental income is not reported on the FAFSA.) *

How many people are in your household, including you? *

Taxable Income is not the same as Adjusted Gross Income or Total Income. Taxable Income can be found on line 15 of the 1040 tax form. If you have any questions, please call (386) 506-3866.

TRiO SSS Income Verification is determined by the number of people in the student’s household (including the student) and federal TRIO program income levels.

What is your taxable income from 2022 or 2023? Enter a dollar amount or give an explanation. (We will need to follow up with you to obtain financial documentation for our records.) *

Income Verification Signature

Please read the following statement, then sign and date.

By signing this Income Verification Form, I am verifying that the financial information that I have provided to the DSC TRiO Student Support Services program is true and correct. This information is protected by the Privacy Act (5 USC 552a). No one may see the information unless they work with or for the DSC TRiO Student Support Services program or are specifically authorized to see it. DEPENDENT students must have a parent or guardian sign this Income Verification.

Income Verification Signature (Parent signature for a dependent student; Student signature for an independent student) *

Signature Type: Simple Start Over

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Signature: (Type in your full name)

I agree to the terms included.

SECTION 5: Tailored Academic Plan (TAP)

What is your career goal? *

What degree are you currently pursuing at Daytona State College? *

What is your expected graduation date? *

After you complete your AA, AS, or certificate at Daytona State College, do you plan to continue to get your bachelor’s (4-year degree) here at DSC or elsewhere? *

Where do you plan to pursue your bachelor’s degree? *

Is your desired program limited access? *

Have you visited the college where you plan to transfer? *

Have you adequately researched your career of interest? *

SECTION 6: Graduation Barriers, PART 1: Academic

Are you lacking math skills? *

Are you lacking English/writing/communication skills? *

Are you lacking science skills? *

Are you lacking study/test-taking skills? *

Are you lacking computer/technology skills? *

Have you utilized any DSC academic resources? *

Do you find it hard or awkward asking for help? *

Do you fear failing your classes? *

SECTION 6: Graduation Barriers, PART 2: Financial

Are you lacking finances to stay in school or transfer? *

Are you struggling to provide food for yourself and your family? *

Are you juggling work, home, and school life? *

Do you have stable housing? *

Are you currently working? *

SECTION 6: Graduation Barriers, PART 3: Personal & Situational

Do you have family responsibilities that interfere with school? *

Do you have a good support system? *

Do you have good time management skills? *

Do you feel like you belong here at the college? *

SECTION 7: Essay (Required)

Please upload or use the space below to complete a short essay explaining why you need the services provided by the Daytona State College TRiO Student Support Services program, and how it can help you achieve your educational and career goals.

Student Essay:

Essay upload:

SECTION 8: Photo Release

Photographs of our participants may be included on our website or other college-approved media. We require your authorization to use any photos we take of you.

Please read the following terms and indicate below if you do or do not agree: I hereby irrevocably consent to and authorize the use and reproduction by Daytona State College or any person or organization authorized by Daytona State College of any and all photographs, video tapes, or film which have been taken of me, both singularly and as a part of a group, without any compensation to me. All positives and negatives shall constitute solely the property of Daytona State College.

Do you agree or disagree with the Photo Release? *

SECTION 9: Final Certifying Statement

My signature below indicates that the information given on this application is true and complete to the best of my knowledge. I also certify that the deliberate misrepresentation of the information may subject me to prosecution under applicable state and federal laws. Additionally, I understand that the information given herein is for the receipt of services funded by a Federal grant. The information provided may be disclosed to third parties for the purpose of verifying eligibility requirements, and in an effort to prevent fraud, waste and abuse in providing federal assistance.

Student Signature: *