Iowa Western Community College is committed to providing equal educational opportunity and forbids unlawful discrimination on the basis of race, color, creed, religion, national or ethnic origin, ancestry, genetic information, physical or mental disability, age, sex, sexual orientation, gender identity or expression, pregnancy, marital status, veteran status, AIDS/HIV status, citizenship, or medical condition, as those terms are defined under applicable laws.
Student Information:
Last Name *
First Name *
Middle Name
Gender *
Student ID:
Date of Birth *
Permanent Address: *
Address 2:
Permanent City *
Permanent State *
Permanent Zip *
Cell Phone Number: *
IWCC Email Address: *
What is the best way to contact you? *
Race/Ethnicity: (Please select all that apply)
Caucasian/White
African American/Black
Native Hawaiian or Pacific Islander
Hispanic/Latino(a)
Native American/Alaskan
Asian
Other
Prefer not to disclose
Academic Information:
What is your current grade level in college? *
What is your current enrollment status (credits)? *
Have you attended another college previous to attending Iowa Western Community College? *
If yes, where?
How many college credit hours have you completed so far? *
What is your current program of study? *
Do you plan to transfer to a 4 year institution upon graduating from IWCC? *
If so, which college(s) are you considering?
Please tell us about your career goals. *
Do you plan to be a student athlete while attending IWCC? *
If so, what sport?

Housing Information:

Beginning in the FALL 2022, students accepted into the TRIO/SSS program will have the opportunity to choose to live in the TRIO/SSS Living Learning Community within housing on campus.

What is a Living Learning Community (LLC)?

Living Learning Communities are small groups of students, faculty, and staff who work closely together creating a “community of learners.”  Students who choose to live in an LLC, share a common interest, take one or more classes together, and participate in out-of-class experiences led by staff and faculty.

Purpose and Benefits of the TRIO/SSS LLC

The TRIO/SSS Living Learning Community is designed for the purpose of having a small group of TRIO/SSS students live together, explore common interests and academic pursuits together. All TRIO/SSS students who reside in the corresponding LLC will be required to take certain courses together.  The TRIO/SSS LLC is recognized by the TRIO/SSS program and the College as a high-impact practice (HIP) that impacts student success; primarily retention, progression, and graduation.  Partnerships with staff, administrators, faculty, and other campus partners must be developed to maximize the TRIO/SSS LLC as an extension of the classroom and contribute to student persistence and graduation. The TRIO/SSS LLC program must be consistent with the mission and vision of the College as a whole.

Benefits of Participating in the TRIO/SSS LLC include:

  • Enhanced academic and social opportunities
  • Improved Grade Point Average (GPA)
  • Connection to staff and faculty
  • Increased sense of connection to campus
  • Greater involvement in learning
  • Increased retention
  • Increased academic success, including persistence to graduation
Do you plan live on campus?
Have you completed the housing application? *
If you plan to live on campus and have not completed the separate housing application, you can do so by clicking this LINK.
Are you interested in joining the TRIO/SSS Living Learning Community (LLC)? *

Please note:  Any student who is interested in living in the TRIO/SSS LLC, must select this as their PRIMARY housing preference on his/her/their housing application.

Only those students who are admitted into the TRIO/SSS program will be allowed to live within the TRIO/SSS LLC.  Space is limited to 24 students.

Eligibility Information:

The following information is used to determine eligibility for TRiO/Student Support Services, which is federally funded by the Department of Education and requires that we report statistics about the students we serve.  Applicants are required to complete this section.
Are you a United States citizen? *
If no, are you a permanent resident of the United States?
To better assist you, please select which of the following options that best reflects your top academic need: *
What what are the biggest obstacles that may prevent you from graduating from Iowa Western Community College? *
What is your highest level of education? *
Does your parent(s) or guardian(s) have a bachelor degree (4 year degree)? *
Would you like to use accommodations while attending IWCC? (IEP or 504 in high school) *
If you would like to use accommodations, have you met with Disability Services to set these up? *
Have you applied for (FAFSA) student financial aid? *
If you do not plan to file a FAFSA application, you can provide verification of household income by completing the appropriate TRIO/SSS verification of income form instead.

If you are a DEPENDENT student (based on the Department of Education financial guidelines), please click this LINK to access the dependent student income verification form.

If you are an INDEPENDENT student (based on the Department of Education financial guidelines), please click this LINK to access the dependent student income verification form.

**You can use the submission box below to submit the completed form OR you can email the signed form to TRIO@iwcc.edu.**

Guidelines for determining dependent status:

INDEPENDENT STUDENT

If you answer YES to ANY of the questions belo, then you may be an independent student. You may not be required to provide parental information on your Free Application for Federal Student Aid (FAFSA®) form.

*

If you answer NO to ALL of the questions below, then you may be considered a dependent student and may be required to provide your parents’ financial information when completing the .

DEPENDENCY DETERMINATION QUESTIONS:

  1. Will you be 24 or older by Jan. 1 of the school year for which you are applying for financial aid? For example, if you plan to start school in August 2022 for the 2022–23 school year, will you be 24 by Jan. 1, 2022 (i.e., were you born before Jan. 1, 1999)?
  2. Are you married or separated but not divorced?
  3. Will you be working toward a master’s or doctorate degree (such as M.A., MBA, M.D., J.D., Ph.D., Ed.D., etc.)?
  4. Do you have children who receive more than half of their support from you?
  5. Do you have dependents (other than children or a spouse) who live with you and receive more than half of their support from you?
  6. Are you currently serving on active duty in the U.S. armed forces for purposes other than training?
  7. Are you a veteran of the U.S. armed forces?
  8. At any time since you turned age 13, were both of your parents deceased, were you in foster care, or were you a ward or dependent of the court?
  9. Are you an emancipated minor or are you in a legal guardianship as determined by a court?
  10. Are you an unaccompanied youth who is homeless or self-supporting and at risk of being homeless?

*If you don’t answer “yes” to any of the questions above, you’re still considered a dependent student for purposes of applying for federal student aid even if you don’t live with your parents, are not claimed by your parents on their tax forms, or are paying for your own bills and educational expenses.
Income Verification Form Submission Box
Disclaimer:
Information received on this application will be held highly confidential. The application and any part of its contents will not be released to anyone other than program staff without a written statement from you.
 
All of the information on this application is true and accurate to the best of my knowledge. I understand that the college reserves the right to admit or deny any student enrollment in the TRiO/SSS program. Completion of application does not guarantee acceptance into program.
Please note, by signing this application you are agreeing to:

 

1. If accepted into the program, I allow my name and/or picture to be printed in any TRiO newsletter, publication, social media, or display in recognition of academic success, leadership, or graduation.

2. I also agree to meet with my TRIO advisor at least once each semester and notify the program if my contact information changes or I change my academic program.
3. As a participant of the TRIO program, I also give permission to discuss issues related to my academic progress with any instructor and/or staff for the purpose of coordinating academic and personal support services (as long as I remain an active participant of the program).
Student Signature:
Student Signature *
Please select a signature verification type.
By typing your full name, you are providing your electronic signature to this application.
The TRiO/SSS staff reserves the right to deny admission to the program even if you meet the criteria for eligibility. You may be denied admission to TRiO/SSS if you: · Have a history of very poor academic performance · Demonstrate an erratic enrollment pattern · Already have an associate’s degree or higher · Are disrespectful or abusive to TRiO staff or students · If there are no slots available · Other circumstances on a case by case basis.