Thank you for your interest in our Student Support Services program! Please complete this application as thoroughly as possible. You cannot save and restart this application. If you have any questions, please call our office at 828-448-3505 or 828-448-3504. You can also email sss@wpcc.edu.
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General Information
First Name *
Last Name *
Middle Initial *
Date of Birth *
Permanent Address *
Local Address
City *
State *
Zip Code *
Cell Phone Number
Home Phone
Email Address
Gender *
WPCC Student ID # *
Are you American Indian or Alaskan Native? *
Are you Asian? *
Are you Black or African American? *
Are you Hispanic/Latino? *
Are you Hawaiian or other Native to Pacific Island? *
Are you White? *
Do you have any impairment, disability, or other condition which may require services that could better your academic success? *
If yes, has documentation related to the disability or impairment been submitted to the Disability Services Coordinator?
Are you a U.S. citizen? *
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Academic Information
Degree/Program at WPCC: *
Have you already attained a Bachelor's Degree from a 4-year University? *
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Family Information
Has your mother received/earned a 4-year college degree? *
Has your father received/earned a 4-year college degree? *
Which parent did you regularly reside with and receive support from during your childhood (i.e. until you were 18 years old)? *
Are you a financially independent or dependent student? (If you're under 24 years old and are claimed on parent/guardian taxes = dependent) *
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Financial Information
What is the total number of persons (including you) in your family? *
Do you authorize TRIO SSS permission to secure any necessary financial records from the WPCC Financial Aid Office to verify eligibility for program participation? *
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By signing this application, I attest that all the information on this application is true. Moreover, I authorize the release of the student's official academic, financial aid, and disability records to the TRIO Student Support Services (SSS) project at Western Piedmont Community College (WPCC), understanding that the information in these records will be used only to assess the student's need for TRIO program services, discern the student's educational progress, evaluate the effectiveness of TRIO program activities, and fulfill TRIO program-reporting requirements. Finally, I authorize this SSS project to use the student's name, statements and likeness, without charge, for promotional purposes in the project's publications, advertising, video, and other forms.
Please sign your name: *
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Signature: (Type in your full name)
I agree to the terms included.