TRIO SSS Application

First Name

Preferred Name

Middle Name

Last Name

Birthdate

Mailing Address

Country

Street

City

Region

Postal Code

Email Address

Phone Number (Mobile)

May we text you?

Select your country of citizenship

Are you a Permanent Resident of the United States?

Are you a current student at Carl Sandburg College?

Anticipated Entry Term

Are you planning on transferring to a four-year college or university?

Have you filed the Free Application for Federal Student Aid (FAFSA)?

Are you a current Upward Bound, Upward Bound Math-Science, or Gale Scholar student?

Do you have a documented physical or learning disability?

Do either of your parents (including step-parents) hold a Bachelor's Degree?

What is your household taxable income (Line 15 of the 1040 tax form)?

How many people, including yourself, live in your household?

What career fields are you considering?

Educational Barriers

Students may face several barriers to their academic and professional success. Below are some common barriers students may face. Please check the box next to each barrier you are currently experiencing:

Educational Barriers

Students may face several barriers to their academic and professional success. Below are some common barriers students may face. Please check the box next to each barrier you are currently experiencing:

Lack of advising and assistance in course selection.

Difficulty completing the FAFSA (Free Application for Federal Student Aid.

Difficulty understanding how to apply for financial aid, scholarships, and obtain financial assistance.

Difficulty understanding your degree plan and making satisfactory progress toward graduation.

Challenges understanding how to apply for and transfer to a 4-year college or university.

Difficulty choosing a career and understanding career options.

Challenges applying financial literacy concepts (i.e. budgeting and managing household finances.)

Difficulty having the necessary resources to meet basic living needs (i.e. housing, food, clothing, etc.)

If other, please specify:

TRIO SSS Disclaimer

I authorize the Sandburg TRIO SSS program to obtain, copy, review and discuss records including high school transcripts, course registration for each semester, enrollment verification, and transcripts from Carl Sandburg College and other colleges, academic progress reports, financial aid records, and standardized test scores. I understand the College reserves the right to admit or deny any student enrollment in the TRIO SSS program. Completion of the application does not guarantee acceptance into the program. The number of spaces available in TRIO SSS is limited. Students will be accepted on a first-come, first-served basis within eligible categories. I also certify that all of the above information is true and complete to my knowledge.
The College, an equal opportunity/affirmative action employer and educator, complies with applicable federal and state laws prohibiting discrimination, including Title VI, Title IX, Section 504, Age Discrimination Act, and Title II of the ADA. It is the policy of the College that no person, on the basis of race, color, religion, gender (sex), sexual orientation, national origin, age, disability, or veteran’s status, shall be discriminated against in employment, in educational programs and activities, or in admissions. Title IX Coordinator Michelle Johnson, 309.341.5258; ADA/Section 504 Coordinator Stefani Gillen, 309.341.5262.

TRIO SSS Disclaimer

I authorize the Sandburg TRIO SSS program to obtain, copy, review and discuss records including high school transcripts, course registration for each semester, enrollment verification, and transcripts from Carl Sandburg College and other colleges, academic progress reports, financial aid records, and standardized test scores. I understand the College reserves the right to admit or deny any student enrollment in the TRIO SSS program. Completion of the application does not guarantee acceptance into the program. The number of spaces available in TRIO SSS is limited. Students will be accepted on a first-come, first-served basis within eligible categories. I also certify that all of the above information is true and complete to my knowledge.
The College, an equal opportunity/affirmative action employer and educator, complies with applicable federal and state laws prohibiting discrimination, including Title VI, Title IX, Section 504, Age Discrimination Act, and Title II of the ADA. It is the policy of the College that no person, on the basis of race, color, religion, gender (sex), sexual orientation, national origin, age, disability, or veteran’s status, shall be discriminated against in employment, in educational programs and activities, or in admissions. Title IX Coordinator Michelle Johnson, 309.341.5258; ADA/Section 504 Coordinator Stefani Gillen, 309.341.5262.

I confirm that I have read and agree to the TRIO SSS Disclaimer

In place of your signature, please type your full legal name: