ALAMOSA CAMPUS PROGRAM

To determine eligibility, please complete this form. The information you provide is strictly confidential. Student Support Services is funded by the Department of Education and requires the following information. Students who wish to participate must meet certain requirements.

(If you are receiving financial aid from another post-secondary institution, you DO NOT qualify for TSC-SSS)
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Personal Information:
First Name: *
Middle Name:
Last Name: *
Student ID: *
Date of Birth: *
Gender *
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Contact Information:
Mailing Address: *
City: *
State: *
Zip Code: *
Personal Email: *
Cell Phone: *
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Race & Ethnicity:

Are you: (Please select Yes to all that apply & No to all of those which do not apply)
American Indian or Alaskan? *
Asian? *
Black or African American? *
White? *
Hawaiian or other Native to Pacific Island? *
Hispanic / Latino? *
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Eligibility:
Are you a US Citizen or Permanent Resident? *
If Permanent Resident, Resident Alien Number:
Father's Highest Education: *
Mother's Highest Education: *
Have you completed the FAFSA ? *
Are you receiving a Pell Grant? *
How many people are in your household? *
Most recent tax return
Are you disclosing a disability? *
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Academic Information:
Enrollment (select one): *
After I complete my AA/AS/AAS/AGS at TSJC, I plan to transfer to a four-year institution: *
What is your enrollment status? *
What is your intended Program of Study? *
Current College GPA or High School GPA: *
After high school graduation, did you wait more than 5 years to start college? *
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Permission to Release Student Information:

Information shared by you will be treated confidentially. Any disclosure outside of Student Support Services will be done only with your written permission and consent. Exceptions to this are:

1. If there is a strong indication you may be in danger to yourself or to others; or have participated in an illegal, unethical, or threatening behavior.

2. If there is any suspicion of abuse or neglect, including abuse of children, the elderly, and those with disabilities.

3. If records must be released pursuant to a valid court order from a judge and/ or

4. In case of a federal or state audit during which student academic records must be made available to auditors at their request.

I grant permission to the Student Support Services program staff to secure the necessary information for my participation in the SSS program and success at Trinidad State College (e.g. financial data, standardized test scores, college and high school transcripts, mid-term grade requests from instructors) from the Financial Aid Office, Admissions, Records, academic departments and other places of record that SSS deems necessary.

I authorize SSS staff to release information to TSC faculty and staff, or gather information from faculty and staff, pertinent to my participation in SSS and Trinidad State College.

I certify that all information I have provided is true and correct to the best of my knowledge. By signing this form, I authorize Trinidad State College Student Support Services staff to use the data provided in this application to assist in assessing any academic and career-planning needs.

I understand that all information will be kept strictly confidential.

I give permission for SSS to use photographs of groups that include me on websites and other program related publications.

This release will be valid until rescinded by me:
Student Signature: *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.
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To finalize your application press the Submit button below!