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2021 - 2022 Program Excel Eligibility Form – Independent Students

This information will be used to determine your eligibility for Program Excel, a U. S. Department of Education TRIO grant-funded program. The information you provide will be kept strictly confidential.

This form only applies to you if the federal government has determined you have Independent Student Status (24 or older, married, have dependent children, emancipated minor, or active in military, etc.) If your parents claim you on their taxes, you are not considered Independent.

Please complete the Eligibility Form for Parents if you are not Independent.

If you regularly lived with and got financial support from only one parent, answer this question for only that parent.
Tax Verification for 2020
(This is not adjusted gross income or total income.)
Note: if you do not have a copy of your Federal Income Tax Return, visit to get a copy of your Tax Transcript online.
You may be eligible for other services!
In college, you must register with Disability Services to receive accommodations (extra time on tests, etc.). If you had an IEP/504 plan or have any of these conditions: learning disability, ADD/ADHD, mental health condition, mobility impairment, vision or hearing impairment, medical condition, you should contact Ruth Montz, Disability Services, at to determine if you qualify for accommodations. It is in your best interest to contact Disability Services at the beginning of your first college semester. In college, disability information is kept confidential and you determine who that information is shared with.
Questions? Contact Dee Dee Snyder (330) 287-1223,
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