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TRIO Student Support Services Program

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- TRIO Application 2026-2027
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TRIO Running Start

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TRIO Program
TRIO Application
TRIO Application 2026-2027

TRIO Application 2026-2027

Current Page 1
Complete

Fields denoted with an asterisk (*) are required

PART 1: PERSONAL DATA

First Name

Last Name

The name I go by is:

Phone or Cell number at which we can reach you at most

NJC Student Number (S#)

Birthdate

Birthdate: Month

Birthdate: Day

Birthdate: Year

Age

Gender

I want to attend Running Start on Aug. 9th-12th, 2026

Yes

PART 2: RACE

Please select ALL that apply

American Indian/Alaskan Native

Asian

Black or African America

Native Hawaiian or Other Pacific Islander

White

PART 3: CITIZENSHIP

Are you a United States Citizen or permanent resident?

PART 4: ETHNIC ORIGIN

Hispanic/Latino (Select YES if you are a person of Cuban, Mexican, Puerto Rican, South or Central American or Spanish culture or origin)

PART 5: EDUCATIONAL INFORMATION

Please select what you graduated with

Graduation Year

Graduation Year : Year

NJC Major

First Enrollment at NJC (Excluding classes taken in highschool)

First Enrollment at NJC (Excluding classes taken in highschool): Year

First Enrollment at NJC (Excluding classes taken in highschool): Month

Is your goal to transfer to a four-year college or university?

Do you have a documented disability that effects learning?

PART 6: FIRST GENERATION VERIFICATION

Did your mother/legal guardian graduate with a 4-year Bachelor degree from a college or university?

Did your father/legal guardian graduate with a 4-year Bachelor degree from a college or university?

Who were you living with up to your 18th birthday?

Enter other…

PART 7: NEED FOR ACADEMIC SERVICES

Please check ALL the goals you may consider using for your educational support:

Academic Tutoring and/or Study Groups

Improve my study skills (note-taking, test-taking, textbook reading, writing, time management, etc.)

Assistance with Career or Personal Counseling

Assistance in transferring to a 4-year college

Assistance with Academic Advising

Assistance in obtaining and/or applying for financial aid

PART 8: INCOME VERIFICATION

I am considered a/an:

Description of student types:

Dependent Student: You are considered a Dependent Student if you were claimed on your parents' income tax return in 2025. All information below is to be completed based on your PARENTS'/Guardians' entire household and should be filled out by YOUR PARENTS.

Independent Student: You are considered to be an Independent Student if you meet any of the following criteria:

I will be 24 or older by December 31 of this year.
I have been an orphan, in foster care, or a ward of the court after age 13.
I have children who receive more than half their support from me.
I am married (or separated, but not divorced).

Check ALL that apply to you being an Independent Student

I am age 24 or older by December 31 of this year.

I have been an orphan, in foster care, or a ward of the court after age 13.

I have children who receive more than half their support from me.

I am married (or separated, but not divorced)

Size of family unit including Student in 2025 (Select one):

Enter other…

State of Residence in 2025 (Select one):

Enter other…

2025 Taxable Household Income (Taxable household income can be found on the federal income tax return, IRS Form 1040, line 15)

Enter other…

PART 9: AUTHORIZATION STATEMENT

If you are under 21, please answer the following statement:

I certify the information provided on this application is true and complete to the best of my knowledge. I understand this information is confidential and will be used for grant purposes. I hereby authorize MLC TRIO to secure information pertinent to my participation in MLC TRIO at NJC. This release covers, but is not limited to, access to financial aid information, standardized test scores, transcripts, grade reports, my instructors and any information concerning my academic progress and performance to generate necessary reports to insure continued operation of the facility. The MLC TRIO office will request and share this information as deemed necessary to further student success. Additionally, student images maybe used from time to time for publicity purposes.

All information provided on this form is true and correct, and all the fields are complete.

Signatures:

Student Signature (required)

Sign above

Today's Date

If student IS A DEPENDENT, a parent/legal guardian MUST SIGN to verify income.

If your parent is not available to sign please click here and then provide their email address so the income verification can be emailed to them for completion.

Parent/Guardian's Email Address:

Parent/Guardian Signature (DEPENDENT Students)

Sign above

CAPTCHA

Math question (1 + 7 =) Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

This program was developed under a TRIO Student Support Services grant from the Department of Education (ED). However, activities do not necessarily represent the policies of ED, and you should not assume endorsement by the Federal Government. AY2627

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