Personal Information:

Last Name

First Name

Middle Name 

                         

Street Address:


City: 

State:

Zip:

E-Mail: 

Home Phone:

Cell:

U.S. Citizen:   Yes   No

Previous TRiO Participation:

Have you have participated in either of the following TRiO programs, please put a check by each one:    UPWARD BOUND, EDUCATIONAL TALENT SEARCH

Educational Level of Your Parents:

Completed a 4-year college degree: Father Mother Both Neither
You live with (or lived with until you were 18) Father Mother Both

Disability:

Do you have a diagnosed disability? Yes  No  If yes, please explain where and when was your disability diagnosed?

Financial Status:

Did you apply for financial aid for the upcoming academic year by submitting the 2008-2009 FAFSA? Yes  No  approximately when did you mail your application? ______________________________________________________________________________

Please provide the following information from your (or your parent’s) current tax return, (same information when filing the FASFA).

[Note: If your parents claimed you on their income tax return, please have them complete the following information and sign below. If you are not claimed as an exemption on your parent’s tax return, please complete the following information from your own tax return.]

ADJUSTED GROSS INCOME

TAXABLE INCOME

NUMBER OF EXEMPTIONS CLAIMED