TRiO Application The Student Support Services (SSS) Program at Frank Phillips College, Borger campus, is a federally funded TRiO Program designed to ensure the success of students who may face obstacles or are considered to be at high risk of not completing their college education. Our mission is achieved through peer and faculty mentoring, academic tutoring, financial literacy seminars, leadership and career development workshops, advice and assistance in postsecondary course selection, community involvement, cultural enrichment and transfer assistance. To be eligible for TRiO services, a student must be first generation and/or low-income and/or have a physical or learning impairment, and documentation MUST be submitted for qualification into the program.General Information:Name First MI Last Name you prefer to be called First Last Gender Male Female Prefer not to Answer Pronouns He/Him/His She/Her/Hers They/Them/Theirs Other If Other Please Define: Citizenship U.S. Citizen or U.S. National Permanent Resident Other Are you a veteran of the United States military? Yes No Address Street Address City State / Province / Region ZIP / Postal Code Phone Number (cell preferred)Can we send you text messages about events? Yes No FPC Student I.D. # FPC Email Personal Email Program EligibilityAll students must be first generation, low income, or have a disability to qualifyHighest Level of Education Completed by Mother/Guardian 1Less than High SchoolHigh School GraduateSome CollegeAssociates DegreeBachelor Degree or HigherPlease complete for both parents / guardians. Leave blank if not applicable.Highest Level of Education Completed by Father/Guardian 2Less than High SchoolHigh School GraduateSome CollegeAssociates DegreeBachelor Degree or HigherPlease complete for both parents / guardians. Leave blank if not applicable.Race American Indian / Alaskan Native Black / African American Native Hawaiian / Pacific Islander Asian White Ethnicity Hispanic/Latino NOT Hispanic/Latino Are you currently receiving financial aid through Frank Phillips College? Yes No What is the size of your family unit?On 2019 income taxes, I (the student) was: Dependent (I was included on my parents' taxes) Independent ( I cannot be claimed on someone else's taxes) What is the annual income for your household?Do you have a documented disability or any learning impairment? Yes No Are you receiving services from disability services or disability support services? Yes No What services can TRiO provide to help you the most?Release InformationName First Last Consent* I agree to the Release of InformationI certify that the information on this application, self-assessment, and release is accurate and complete to the best of my knowledge. I understand that The Department of Education requires social security number reporting as a condition for TRiO participation, and that my social security number will remain private and confidential. I hereby authorize TRIO Student Support Services to obtain any information from my educational record that may be pertinent to my participation in the program, includ-ing information from Financial Aid, Admissions, the Registrar, Disability Services, FPC employees, and the National Student Clearing House. Your signature gives us the right to use your participation, photos, videos, and likeness to promote the TRiO program. Only applicants who provide documentation or referrals will be admitted into the program.Frank Phillips College is an equal opportunity education institution and employer. Its students and employees are selected and/or assigned without regard to age, race, color, creed, sex, national origin, or disability, consistent with Titles VI and VII of the Civil Rights Act of 1964, and Title IX of the Higher Education Act amended in 1972, and Section 504 of the Rehabilitation Act of 1973. The compliance coordinator for Title IX is Dr. Shannon Carroll (email@example.com; (806) 457-4200, ext. 732) and Section 504 is Becky Green (firstname.lastname@example.org; (806) 457-4200, ext. 777). Frank Phillips College no discrimina por motivos de raza, edad, religión, color, origen nacional, sexo o impedimento en sus programas, servicios o actividades según requerido por el Título VI de la Ley de Derechos Civiles de 1964, según enmienda; el Título IX de las Enmiendas de Educación de 1972; y la Sección 504 de la Ley de Rehabilitación de 1973, según enmienda. FPC también proporciona igualdad de acceso a los Boy Scouts y a otros grupos de jóvenes designados. Preguntas con respecto al cumplimiento y/o procedimientos de queja pueden ser dirigidas al oficial del Titulo IX , Dr. Shannon Carroll, 1301 West Roosevelt, Borger, Texas 79007, (806) 457-4200, ext. 732 y/o al Coor-dinador de la Sección 504/ADA del distrito escolar, Becky Gren, 1301 West Roosevelt, Borger, Texas 79007, (806) 457-4200, ext 777, email@example.com.