First-Year College Experience Program
-73660025400Please check one of the following:I am interested in… ? Becoming a TRiO SSS participant AND attend the First-Year College Experience. ? Becoming a TRiO SSS participant only. Return application to:Wallace Community CollegeTRiO SSSWallace Campus1141 Wallace DriveDothan, AL 36303-9234 OrTRiO SSSSparks CampusP.O. Drawer 580Eufaula, AL 36027-0580Phone Numbers:334-556-2620334-983-3521, ext. 26201-800-543-2426, ext. 2368Fax:334-983-6202E-mail:jlyman@wallace.edu00Please check one of the following:I am interested in… ? Becoming a TRiO SSS participant AND attend the First-Year College Experience. ? Becoming a TRiO SSS participant only. Return application to:Wallace Community CollegeTRiO SSSWallace Campus1141 Wallace DriveDothan, AL 36303-9234 OrTRiO SSSSparks CampusP.O. Drawer 580Eufaula, AL 36027-0580Phone Numbers:334-556-2620334-983-3521, ext. 26201-800-543-2426, ext. 2368Fax:334-983-6202E-mail:jlyman@wallace.edu-43254925400 TRiO First-Year College Experience Program914400160655Name: Last Name M.I First Name Social Security Number: Date of Birth: Address: City: State: Zip Code: Cell Phone: Work Phone: E-mail Address: @ Are you a U.S. Citizen? Race (optional) Gender (optional)How did you hear about TRiO Student Support Services? Choose an item.Have you ever been a participant in (check all that apply)Upward Bound ?Talent Search ? EOC ? SSS ?Tell us a little about your college plans:What is your intended program of study? Major Do you plan to transfer to a 4-year college or university? Yes ? No ?Name of 4-year College or university where you plan to transfer: Name of CollegeDid either of your parents graduate with a bachelor’s degree from a 4-year college or university? Yes ? No ?Who did you regularly reside with and receive support from? Mother only?Father only ?Both parents ?Guardian ?Do you have a disability that is documented through the office of Disability Services? Yes ? No ?Are you registered with Vocational Rehabilitation? Yes ? No ?Do you currently receive financial support from your family? Yes ? No ? (If “No” go to Section B)Section A: What is the size of your family’s household, including yourself? Household # Does your family file a Federal Income Tax Return? Yes ? No ? If yes, for the most recent tax year, what was their “taxable income”? $ Section B: What is the size of your household, including yourself and other dependents? __ Do you file a Federal Income Tax Return? Yes ? No ? If yes, for the most recent tax year, what was your “taxable income”? $ Academic Eligibility Information:High School Graduate? Yes ? No ? High School GPA GPA ACT Scores; verbal ACT___________ ACT Scores; math ACT SAT Scores; verbal SAT __________ _ SAT Scores; math SAT By signing this document, I attest the information to be true and accurate to the best of my knowledge. 00Name: Last Name M.I First Name Social Security Number: Date of Birth: Address: City: State: Zip Code: Cell Phone: Work Phone: E-mail Address: @ Are you a U.S. Citizen? Race (optional) Gender (optional)How did you hear about TRiO Student Support Services? Choose an item.Have you ever been a participant in (check all that apply)Upward Bound ?Talent Search ? EOC ? SSS ?Tell us a little about your college plans:What is your intended program of study? Major Do you plan to transfer to a 4-year college or university? Yes ? No ?Name of 4-year College or university where you plan to transfer: Name of CollegeDid either of your parents graduate with a bachelor’s degree from a 4-year college or university? Yes ? No ?Who did you regularly reside with and receive support from? Mother only?Father only ?Both parents ?Guardian ?Do you have a disability that is documented through the office of Disability Services? Yes ? No ?Are you registered with Vocational Rehabilitation? Yes ? No ?Do you currently receive financial support from your family? Yes ? No ? (If “No” go to Section B)Section A: What is the size of your family’s household, including yourself? Household # Does your family file a Federal Income Tax Return? Yes ? No ? If yes, for the most recent tax year, what was their “taxable income”? $ Section B: What is the size of your household, including yourself and other dependents? __ Do you file a Federal Income Tax Return? Yes ? No ? If yes, for the most recent tax year, what was your “taxable income”? $ Academic Eligibility Information:High School Graduate? Yes ? No ? High School GPA GPA ACT Scores; verbal ACT___________ ACT Scores; math ACT SAT Scores; verbal SAT __________ _ SAT Scores; math SAT By signing this document, I attest the information to be true and accurate to the best of my knowledge. -14732002065655 ................
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