Submit Your Application

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. You may want to review the included items, take some time to make notes and gather the required documents, and then return to submit your application. If you have any questions, please call our office at (252) 222-6020.

Applicant Information:

Last Name: *

First Name: *

Middle Name:

Date of Birth: *

Current Age: *

Address 1: *

Address 2:

City: *

State: *

Zip Code: *

Home Phone

Cell Phone Number: *

Student Email Address: *

Alternative Email Address: *

Preferred Contact Method *

Demographic Information:

Gender: *

Are you a US Citizen or Permanent Resident? *

Race: *

Ethnicity: *

Are you a Veteran or Veteran Dependent? *

Academic Information

Are you currently accepted or enrolled at Carteret Community College? *

Major: *

Do you plan transfer to a 4-year college/university? *

What is your Current Academic Status *

Current Financial Aid Status *

Have you earned a 2-year or 4-year degree? *

TRIO Eligibility

First Generation Verification

The term “first generation college student” means—
(A) an individual both of whose parents did not complete a baccalaureate degree; or
(B) in the case of any individual who regularly resided with and received support from only one parent, an individual whose only such parent did not complete a baccalaureate degree.

Parent 1 Highest Educational Level *

Parent 2 Highest Educational Level: *

Income Eligible Verification

The term “low-income individual” means an individual from a family whose taxable income for the preceding year did not exceed 150 percent of an amount equal to the poverty level determined by using criteria of poverty established by the Bureau of the Census.

Number in Household/Size of Family Unit? *

Do you have children that reside with you *

What is your marital status *

If you are 24 and older, you should not include your parent's income.

If you are married or have children, you should not include your parent's income

Please submit below your previous years taxable income (income minus deductibles). You can find your taxable income on line 15 of your tax return. You may also upload your tax information at the end of this application. Please note that dependent students will need to have a parent's signature.

Family's Taxable Income from most recent tax year *

Disability Verification

Students with a documented disability.

Do you have Documented Disabilities *

Budgeting & Money Management

TRIO Services

What services are you requesting in TRIO? Please check all that apply

Academic Advising/Counseling

Transfer Assistance/Campus Visits

Financial Aid& FAFSA Assistance

Improve Study Skills & Success

Tutoring

Test Taking & Anxiety

Career Exploration & Assistance

Selecting a Major/Understanding College

Certification and Signature

I attest that all the information provided is true and accurate to the best of my knowledge. I give permission to SSS to review, obtain or make copies of all necessary CCC and prior educational documents (i.e. financial aid records, high school & college transcripts, assessment results, etc) in order to determine program eligibility and/or enhance the effectiveness of the program and services provided. I

I give permission to SSS to track my enrollment upon completion of my program through National Student Clearinghouse.

Sign and Submit:

Applicant Signature *

Please select a signature verification type.

If you would like to upload your Taxable Income, please upload it here