The TRIO Student Support Services Program is federally funded by the U.S. Department of Education. It’s mission is to promote the retention, graduation and transfer of college students. All services are provided at no cost to qualifying students. Students who desire to participate in the program’s activities must meet certain requirements established by the Department of Education and the Higher Education Act of 1965. By completing this form, we will be able to accurately determine your eligibility and collect statistical data. 

Please ask a staff member if you need assistance filling out this form or call our offices at 702-992-2550.

Please complete this application as thoroughly as possible. You cannot save and restart this application.  You may want to review the included items, take some time to make notes and gather the required documents, and then return to submit your application.
Contact Information:
NSHE ID *
Last Name: *
First Name: *
Middle Name:
Date of Birth: *
Address: *
Address 2:
City: *
State: *
Zip Code: *
Home Phone *
Cell Phone Number:
Email Address: *
Describe your primary reason for applying: *

Demographic Information:
Gender: *
Marital Status
Ethnicity: (According to federal definitions)
Race, Hispanic *
Race, Asian *
Race, American Indian or Alaskan Native *
Race, White *
Race, Black or African American *
Race, Hawaiian or other Native to Pacific Island *
Academic Information:
Current Grade Level: *
How many classes are you taking?
How's your academic standing?
Current GPA: *

If a recent high school graduate, write down your final high school GPA.
Eligibility:
Are you a U.S. Citizen? *
If not, are you a permanent resident?
Do you have a physical or learning disability?
If yes, you MUST submit documentation from the DRC Office.
Are you eligible for any financial aid? *
What type of financial aid are you receiving? (Select all that apply or select “None”)
Pell Grant
Work Study
Fee Waiver
None
Family Information:

Parent's Educational Level

What educational level has your parent(s) completed within the U.S. and/or U.S. territories? If applicable, select one for each parent.

Parent 1:
Bachelor's Degree or Higher
Associate's Degree
Certificate
High School Diploma/GED
None of the above
Parent 2:
Bachelor's Degree or Higher
Associate's Degree
Certificate
High School Diploma/GED
None of the above
How many people in your household at home? *
Family Income Range: *
Are you under the age of 24 and a dependent under your families tax forms? (If yes, please check the box below and submit a signed tax form)
Sign and Submit:

Terms of Submission:

I verify that the information on this form are correct and complete. I understand that my acceptance to the Student Support Services Program depends on the accuracy of my answers. 
Applicant Signature: *
Signature Type: Simple    Start Over
Click here to start signing.
  • Pencil
  • Reset
Signature: (Type in your full name)
I agree to the terms included.

Program Release of Information:

Most family and students’ information provided to Nevada State College TRIO-SSS (NSC) is confidential and will not be released without the students’ permission. NSC TRIO-SSS would like your permission to access and release Family and student information for the following reasons:

  • Each year NSC must report student progress and eligibility information to the U.S. Department of Education to demonstrate program effectiveness when requesting renewed funding.
  • NSC Financial Aid will provide us eligibility and Financial Aid Award information.
  • Academic progress monitoring with faculty, instructional support staff and the TRIO-SSS Peer Mentor staff for the purpose of students’ continued academic success and possible intervention by program staff. 
  • Third party texting service for the purpose of academic coaching and school deadlines/reminders

 

By signing below, I give NSC TRIO-SSS permission to release information for the above purposes. I verify that all information provided in this application is true and accurate.
Applicant Signature: *
Signature Type: Simple    Start Over
Click here to start signing.
  • Pencil
  • Reset
Signature: (Type in your full name)
I agree to the terms included.
Program Photo/Media Release:

Much of our publication and marketing success is from the use of photos and videos taken of TRIO-SSS students during program events. By signing below, you give the irrevocable right to use your name, photo, or video in all forms and media and in all manners, including composite or distorted representations, for advertising, trade or any other lawful purposes, and you waive any right to inspect or approve the finished version(s), including written copy that may be created in connection therewith. 

By signing below, I verify that I am at least 18 years of age, I have read this release and am fully familiar with the contents.
Applicant Signature: *
Signature Type: Simple    Start Over
Click here to start signing.
  • Pencil
  • Reset
Signature: (Type in your full name)
I agree to the terms included.