The Student Support Services (SSS) program at WCSU requires verification of income eligibility to determine program participation. By signing this form, you authorize the WCSU Financial Aid Office to share your income information with the SSS program for eligibility determination. I hereby give permission to the WCSU Financial Aid Office to release my income information, including FAFSA or FTI Data, and/or tax documentation, to the WCSU Student Support Services program. 

I authorize the WCSU Financial Aid Office to release my income information to the WCSU Student Support Services program solely for the purpose of determining my eligibility. This information will be kept confidential and used in accordance with university policies and applicable federal privacy regulations.

If you choose not to consent to the release of your financial information, the SSS program will be unable to verify your income using required documentation. Without verified income information, the SSS program cannot determine eligibility, and you may be found ineligible to receive SSS services.

By selecting “I DO NOT consent,” you acknowledge and understand that:

• Income verification is required to establish eligibility for the SSS program; and
• Without your consent or submission of acceptable alternative documentation, your application may be denied or your participation in the program may be discontinued.

If selected, upon my acceptance to the WCSU TRIO SSS program, I agree to fulfill all my requirements as a program Scholar and be committed to my academic and personal achievements at Western Connecticut State University. I also agree to the following:

• I will meet with staff once a month during the fall and spring semester throughout my academic career at WCSU to review my progress.
  
  

• I agree to participate in workshops and activities provided by the WCSU SSS program and will attend at least two (2) workshops during each semester
  
  

• I must attend tutoring sessions during the semester in the PCAAP Student Success Center (Warner Hall 102), if referred by my counselor
  
  

• I agree to enroll in and to maintain a minimum of 12 credits per semester and successfully complete at least 24 credits during each academic year
  
  

• I accept the responsibility for acquainting myself with registration, withdrawal, and refund policies and procedures set forth in the current WCSU Catalog and Schedule.

  
  

I, hereby certify that all answers and information provided, constitute a full and complete disclosure with respect to this application. I understand that this application is being made in connection with the receipt of federal funds, and the U.S. Federal Government and the U.S. Department of Education may verify this information.