January 2017 1

Congratulations on your decision to attend Monterey Peninsula College (MPC) and applying to the MPC TRIO Student Support Services (SSS) program! The MPC TRIO SSS is a positive step in the direction of your academic and personal success, especially for students who have a strong desire and commitment to transfer from the community college to a four-year institution.

Please use the checklist below to ensure you submit all necessary materials. Attach this page as the cover of your application. All items need to be included for your application to be considered complete. If selected, you will be invited to attend an interview with the SSS Coordinator/Counselor.

If you have any questions, please contact the TRIO SSS office at (831) 646-4246 or via email at triosss@mpc.edu

Mail Application Packet to: TRIO SSS

Monterey Peninsula College 980 Fremont Street

Monterey, CA 93940

OR Drop-Off Application Packet to: MPC TRIO SSS Office

2nd Floor Student Services Bldg.

Note: Place ALL application materials in a sealed large envelope, and include first and last name. Do not fold the application. Submit all items in the order listed below.

STUDENT NAME: ___________________________________________________________________

CHECKLIST (initial each item):

SSS Application Cover & Checklist (pg. 1)

SSS Application (pgs. 2-3)

SSS Personal Essay Response

SSS Short Essay Response

Attach High School Transcript & Unofficial AP Scores

Attach College Transcript (colleges attended other than MPC)

Copy of Parent/Guardian’s Most Recent Taxes

Copy of Student's Most Recent Taxes

Copy of Student’s Most Recent FAFSA Report

RETURN ALL DOCUMENTS BY: Priority Deadline – May 1, 2017 Deadline – June 1, 2017 (Open until filled)

STUDENT SUPORT SERVICES CHECKLIST

(OFFICE USE ONLY) DATE APPLICATION RECEIVED: STAFF INITIALS:

OR Email Application Packet to:

triosss@mpc.edu

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STUDENT SUPPORT SERVICES ESSAYS

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STUDENT SUPPORT SERVICES APPLICATION

January 2017 2

Student Support Services is a federal funded TRIO program under the U.S. Department of Education that aids students in graduating from college. Program participants must meet certain requirements set forth by the Department of Education. To determine your eligibility, please fill out the following information completely. Incomplete applications will not be accepted. The information you provide is strictly CONFIDENTIAL. In order for your application to be reviewed, you must also attach a copy of your income verification (See “Financial Eligibility” Pg.3). Please use black or blue ink and print legibly.

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PERSONAL DATA INFORMATION

MPC Student ID #: _______ - _______- _______

PRIN

Social Security Number: _______ - _______ - _______

Name: ___________________________________________________________ Last First MI

Address: ___________________________________________________________________________________________ Zip Code City State

Home #: ___________ Street, Apt #

Cell #: Personal Email: _____________________________ MPC Email:___________________________________ _____

Have you ever enrolled in any school under a different name? Yes No If yes, please specify: ___________________ ETHNICITY (CHECK ALL THAT APPLY)

American Indian/Alaskan Native Asian Black/African American Hawaiian or other Pacific Islander Hispanic White (i.e. Europe, Middle East, North Africa)

EDUCATIONAL INFORMATION

Are you a high school graduate? Yes No Has your high school transcript been submitted to MPC? Yes No

High School Attended: __________________________ H.S. Diploma/GED (date) _ _/ _ _ /_ _ _ _ H.S. GPA:_________

1st Year (less than 30 credits) 2nd Year (30+ credits) Current Class Level at MPC: 1st Year (never attended) Did you attend another college? Yes No If yes, list school(s) NOTE: OUT SIDE TRANSCRIPTS MUST BE PROVIDED Are they already at MPC? Yes No

How many units have you completed at all other college(s)? ________

Do you have an AA/AS degree? Yes No Do you have a Bachelor’s degree? Yes No

ACADEMIC GOALS (CHECK ALL THAT APPLY)

Educational Goals: Associates Degree Bachelor’s Degree Master’s Degree PhD Degree

TRANSFER MAJOR: ________________________________________________________________________________

CITIZENSHIP U. S. Citizen Yes NoPermanent Resident Yes No

•

GENDER

Male

Female

DATE OF BIRTH ___/___/______ MM DD YYYY

MARITAL STATUS M S D W

PROGRAM ELIGIBILITY

Yes NoDid your mother/guardian complete a 4-year degree (Bachelor's) Yes No

Financial Aid Status: (CHECK ALL THAT APPLY) Not approved for financial aid Applied for financial

Did not apply Approved for financial aid Awaiting financial aid award On financial aid warning or dismissal

Do you have a Board of Governor Fee Waiver (BOG)? A B C Not Eligible

Did your father/guardian complete a 4-year degree (Bachelor's)

STUDENT SUPPORT SERVICES APPLICATION

January 2017 3

FINANCIAL ELIGIBILITY

Federal legislation requires that TRIO programs verify the financial eligibility of applicants before they can be admitted. In many cases, the Federal Financial Aid Form (FAFSA) on file with MPC suffices, but in other cases, additional information is needed.

PROOF OF INCOME VERIFICATION

It is a requirement that you bring in: (A) signed copy of your and your parent’s (if applicable) 2016 Federal Tax Return, OR (B) verification of income from another government source, OR (C) a signed financial aid application (Student Aid Report – SAR). If you are under the age of 25, please talk to our SSS Program Specialist for specific information on what income verification you will need to submit.

Information we request will be used only to determine or verify eligibility for TRIO SSS. All information is confidential and is never passed on to any other agency.

I certify the information I provided on this application is, to the best of my knowledge, true and accurate. By applying to this program, I authorize MPC’s TRIO Student Support Services program to access information pertinent to my participation from other MPC departments/programs. I recognize that completing this application does not guarantee my admission to the program.

________________________________________________Applicant Signature Date

DISABILITIES VERIFICATION

Do you have any documented physical and/or learning disabilities? Yes No

If yes, is the disability information on file with the MPC Access Resource Center? Yes No

WHY ARE YOU CHOOSING TRIO SSS? (CHECK ALL THAT APPLY)

Academic Advisement Transfer Advisement Assistance in course selection Tutoring

Financial Aid Advisement Career Counseling

Personal Counseling 4yr – Campus Tours

Have you been a part of another TRIO program? Yes No If yes, where? ___________________ When? ________

Which program? Student Support Services Upward Bound Math Science Upward Bound

Talent Search EOC McNair Gear Up

Office Use Only

FG/LI

LI

FG

Disabled

Disabled/LI

PERS 10

Orientation

FAFSA/Taxes

Cohort Year ___________

N/E

Staff Initials:

Date:

PLACE HEADSHOT

PHOTO

Assistance in improving GPAOther

__________________________________

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STUDENT SUPPORT SERVICES ESSAYS

SSS PERSONAL ESSAY:

One of our program’s goals is for our students to demonstrate their ability to communicate both in verbal and written format their personal, educational and/or career goals. We would like for you to compose an essay that shares with the reader who you are, and what your life experiences have been thus far - your life story.

We know it can be difficult to write about your personal struggles and successes. It is important to acknowledge all aspects of your experiences. These experiences have helped shape who you are and who you are becoming.

On a separate sheet of paper, in no particular order, please answer the following questions in an essay format.

Describe your family (i.e. siblings, two-parent or single-parent upbringing, migrantfamily, etc.); ethnicity (i.e. Asian, African American, Latino, etc.); cultural (i.e. religion,heritage, gender, etc.); and/or socio-economic status (i.e. low-income, middle class,working class, etc.).

“Are you the first in your family to go to college? If “Yes”, what does this mean for you,and why is it important for you to continue a higher education?” If “No”, why is itimportant for you to continue a higher education?

“What are some challenges/obstacles that you have experienced in your academiccareer and/or personal life? How did you overcome and/or grow from thoseexperiences?”

Share any other information that you would like to include about yourself and/orexperiences. (Optional)

Format: No more than (1.5) pages typed; single-spaced; 1 inch margins; font size: 12; font style: Times New Roman or Calibri

SSS SHORT ESSAY:

On a separate sheet of paper, please answer the following question in an essay format.

“How do you think the TRIO SSS program can help you reach your academic and personal goals?”

Format: No more than 500 words typed; single-spaced; 1 inch margins; font size: 12; font style: Times New Roman or Calibri

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STUDENT SUPPORT SERVICES ESSAYS

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MPC TRIO SSS INCOME ELIGIBILITY WORKSHEET 2017

To determine SSS Income Eligibility, please refer to your taxes from the previous year (i.e. for the 2017-2018 academic year, it is based on 2016 taxes). Whether or not your parent/guardian claimed you on their 2016 taxes, typically, students who are under 24 years old, unmarried, and have no children are considered a “Dependent” and you will need your parent/guardian tax information to complete this form.

For FAFSA purposes, I am considered (please circle one): Dependent OR Independent

Indicate Family Size: _____

Adjusted Gross Income: $_________________

Number of Exemptions _____ X $4,000: -$ ________________

Subtotal:

*Standard Deductions (see table below):

Taxable Income:

$_________________ -$ ________________$_________________

*STANDARD DEDUCTION TABLE

Married, filing Jointly $12,600 Single $ 6,300 Head of Household $ 9,250 Married, filing Separately $ 6,300

STATEMENT OF FACT:

I verify to the best of my ability that the information provided on this form is true and accurate.

Student Name (Print):___________________________________________ Date:____________

Student Signature: _____________________________________________ Date:____________

Parent Signature: ______________________________________________ Date:____________ (Only if student is under 18 years old)

******************************************************************************************************************************* STAFF ONLY SECTION

ANNUAL LOW-INCOME LEVEL (Circle Family Size below):

Family Size Taxable Income Less Than Family Size Taxable Income Less Than

1 $17,820 5 $42,660

2 $24,030 6 $48,870

3 $30,240 7 $55,095

4 $36,450 8 $61,335

* Add $6,240 for each additional family member

Other criteria to determine Income Eligibility Status if student/parent/guardian did not file taxes (provide documentation):

___ A or B BOGFW ___ FAFSA

Circle Eligibility: LI OR Not Eligible

Determined by: _______________________________ Date: _____________

Tax Form 1040, line 37 or

Tax Form 1040A, line 21

(Information on taxes: total of lines 6a, 6b, 6c)

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