TRiO Student Support Services Summer Bridge Application

July 19 - 29, 2021


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 Summer Bridge program, you must:

  • be a U.S. citizen or Permanent Resident
  • have a 2.5 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.


Items to gather and upload:

Throughout this application, you may be asked to upload financial information (such as a recent tax return) or proof of a disability to provide backup documentation. Take a moment to locate them now so you can fill out this application more quickly.


SECTION 1: Availability and Diploma
Are you available to attend meetings (in person and/or virtually) July 19 – 29, 2021? *
Will you have earned a high school diploma or a GED diploma by July 1, 2021? *
If you answered "Yes" for high school diploma, enter the name of the high school. If you entered "No" for high school diploma, enter "none" *
Have you completed an application to Daytona State College? *

SECTION 2: Personal Information
Last Name *
Middle Name *
First Name *
Preferred name
Social Security Number *
What is your DSC ID number? (If you don't have one, enter "none") *
Date of Birth *
Gender *
Are you Hispanic? *
Are you American Indian or Alaskan Native? *
Are you Black or African American? *
Are you Asian? *
Are you Hawaiian or other Native to Pacific Island? *
Are you White? *
Current street address; include apartment/building/unit/lot number, if applicable. *
City *
State *
Zip Code *
What is your DSC email address? (If you don't have one, enter "none") *
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 3: Eligibility Information
Does your mother have a Bachelor's Degree or higher? *
Does your father have a Bachelor's Degree or higher? *
Do you already have an AA or AS degree? *
Are you eligible for the Pell Grant? *

SECTION 4: Disability Information
Do you have a documented mental, physical, or learning disability? *
Are you registered with DSC’s Counseling and Accessibility Services (CAS)? *

SECTION 5: Financial Information

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.


SECTION 5: Financial Information, PART 1: Dependent/Independent Student Status

Definitions:

Dependent: Student is younger than 24, unmarried or not emancipated, parental income is reported on the FAFSA.

Independent: Student is at least 24 years old, married or emancipated; parental income is not reported on the FAFSA.


SECTION 5: Financial Information, PART 2: Income Verification

Please note that Taxable Income is not the same as Adjusted Gross Income. Taxable Income can be found on line 11b of the 1040 tax form for 2019. 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.


SECTION 5: Financial Information, PART 2(a): Income Verification - Dependent Student
If you are a dependent student as identified in SECTION 5, PART 1, please answer the following questions. (If you ARE NOT a dependent student,  select "N/A".)
How many people are in your household (including you)? *

As a dependent student as identified in SECTION 5, PART 1, please check the appropriate box below for your parent's actual or estimated taxable income. (If you ARE NOT a dependent student, select "N/A".)

N/A: I am an independent student.
$19,140
$25,860
$32,580
$39,300
$46,020
$52,740
$59,460
$66,180

SECTION 5: Financial Information, PART 2(b): Income Verification - Independent Student

If you are an independent student as identified in SECTION 5, PART 1, please answer the following questions. (If you ARE NOT an independent student, select "N/A".)

How many people are in your household (including you)? *

As an independent student as identified in SECTION 5, PART 1, please check the appropriate box below for your actual or estimated taxable income. (If you ARE NOT an independent student, select "N/A".)

N/A: I am a dependent student.
$19,140
$25,860
$32,580
$39,300
$46,020
52,740
$59,460
$66,180

SECTION 5: Financial Information, PART 3(a): Income Verification - Upload Tax Return
If you or your parent filed a tax return within the last two years, upload it here as a PDF file. (If you or your parent DID NOT FILE a tax return, select "N/A" and complete SECTION 5, PART 3(b).
N/A: My parent or I DID NOT FILE a tax return within the last two years.

SECTION 5: Financial Information, PART 3(b): Income Verification - Self-Report Income (DID NOT FILE Tax Return)
If you or your parent DID NOT FILE a tax return within the last two years, complete the following. (If you or your parent  DID FILE a tax return, select "N/A".)
N/A: My parent or I filed a tax return within the last 2 years.
Self-report your estimated annual income by entering the dollar amount. *
Self-report any other non-taxable income (such as Disability, AFDC, Veterans Benefits, Retirement, Unemployment) by entering the dollar amount. *

SECTION 5: Financial Information, PART 4: Income Verification Signature

Please read the following statement, then sign and date.

By signing this Income Verification Form, I am verifying that the 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.

Income Verification Signature (Parent signature for a dependent student; Student signature for an independent student) *
Click here to start signing.
  • Pencil
  • Reset
Signature: (Type in your full name)
I agree to the terms included.

SECTION 6: Tailored Academic Plan (TAP)
What degree will you pursue at Daytona State College? *
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? (Enter "none" if unsure or don't plan to get a bachelor's degree) *
Is your desired program limited access? *
Have you visited