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Thank you for your interest in the GOCC Student Support Services program!  Please fill out this application as thoroughly as possible. You cannot save and restart this application.  You may want to review the included items, take some time to make notes and gather the required information, and then return to submit your application.  If you have any questions, please call us at (269) 294-4324 or email sssprogram@glenoaks.edu.
General Information:
GOCC ID # *
Last Name: *
First Name: *
Middle Name:
Preferred Name
Date of Birth: *
Mailing Address: *
Mailing Address 2:
City: *
State: *
Zip Code: *
Cell Phone Number: *
May we text you? *
Other Phone (if applicable)
Email Address: *
Legal Gender *
Preferred Pronouns
Are you Hispanic or Latino? *
Are you White or Caucasian? *
Are you American Indian or Alaskan Native? *
Are you Asian or Asian American? *
Are you Black or African American *
Are you Hawaiian or other Native to Pacific Island? *
How did you hear about the TRIO SSS program? *
Eligibility Information:
Program of Study
Are you undecided on your major or career plans? *
What is your first language? *
Do you lack stable housing or are you at risk of losing your housing? *
Citizenship *
Do you have a documented physical, emotional, or learning disability? *

For financial aid purposes, are you a:

  • Dependent Student: Claimed by your parent(s) on their taxes. If you are a dependent student, we will need a parent's signature to fully process your application. We will contact you with options to obtain this after we receive your application. 
  • Independent Student:
    • 24 years of age or older, or
    • married, or
    • veteran or active military personnel, or
    • have legal dependent(s), or
    • an orphan or ward of the court, or
    • deemed independent by the Director of Financial Aid for other circumstances
I am a *
How many people live in your household (incl yourself)? *
2022 Family TAXABLE Income Range (line 15 on tax return) *
Did the parent(s) with whom you primarily live(d) graduate with a bachelor's (4 yr) degree? *
If you are a Dependent student, please include the name and email address of one of your parents or guardians so we can reach out to them to verify program eligibility.
Parent's Name
Parent's email address
Sign and Submit:

SSS Program Applicant Agreement: 

I certify that the information represented on this form is accurate to the best of my knowledge. I understand that by applying for Glen Oaks Community College's TRIO Student Support Services program, I authorize program staff to obtain my academic student records, transcripts, financial, and disability information. I authorize program staff to receive or release information  to coordinate services with other GOCC staff or faculty and as required by law to TRIO SSS and the U.S. Department of Education for the duration of my participation in the program. I also grant TRIO SSS the permission to use my name, photo, or video for media and program purposes. I understand that I reserve the right to revoke this permission to use my likeness at any time by contacting TRIO SSS staff. 
Applicant Signature *
Please select a signature verification type.