TRIO Student Support Services

College *

General Information

First Name *

Middle Initial

Last Name *

Star ID, ie., ab####yz *

College Student ID # (ie, all numbers)

Date of Birth (ie, MM/DD/YYYY) *

Gender

Preferred Email Address *

Cell Phone Number

Background Information

Please respond to ethnicity, race, and other background questions as indicated below:

Is your ethnicity Hispanic or Latino? *

From the following race options listed below, please answer Yes to at least one or more that you identify with.

American Indian or Alaskan Native *

Asian *

Black or African American *

Hawaiian or other Native to Pacific Island *

White *

What is your residency status? *

Do any of these apply to you? (Homelessness or Foster Care)

Are you a military Veteran? *

If yes, check box if the college has received your joint services transcript (JST).

How many prior college institutions have you attended?

If you did take college classes, from where? List college(s):

List any college certificate or degree(s) earned:

What is your current admission status? *

What semester will be your first term of enrollment?

Program Eligibility

SSS will verify your first-generation college-going status from your college application. Generally, this means that neither parent has earned a 4-year degree, although there are other qualifiers we review.

Are you a first-generation college student? *

Check box if you have a documented disability (i.e., physical, mental health, learning)

Have you completed your application for financial aid using the FAFSA? *

How would you self-identify your eligibility to participate in TRIO SSS? *

Select one area of academic need that you most identify with *

If you selected "OTHER" in previous question, list your academic need:

Is your academic and career goals in a STEM or Healthcare field? *

Choose one based on your age and circumstances:

Complete the Parent or Contributor information so the SSS office can verify your TRIO-eligibility based on family size and income. (Skip this part if you are at least 24 yrs old and considered an INDEPENDENT STUDENT.)

Parent or Contributor First Name

Parent or Contributor Last Name

Parent or Contributor Phone (in case email doesn't work)

Parent or Contributor Email

Supportive Services

SSS will go over your academic and personal needs along with the supportive services TRIO Student Support Services can offer and provide to students.

Check all that apply to you.

Academic planning (ie, choosing a major, course selection, registration, degree progress)

Career development (ie, exploring career fields, choosing a career path, career readiness skills)

College success skills (ie, academic & study skills, learning styles, time management, test-taking strategies)

FAFSA completion assistance (including student aid acceptance steps)

Health and wellness (including basic needs resources, personal counseling and mentoring)

Personal development of talents, strengths & abilities

Scholarships (ie, assistance on how to search, apply, and write essays)

Social activities, cultural events and extracurricular academic programming

Study groups and tutoring to improve learning and maintain good grades

Support with online classes (ie, how to log-in, how to navigate online course, upload assignments, etc.)

Transfer preparation to go to a four-year college (including tours, applications & financial aid process assistance)

Understanding college terminology, policies and procedures

Understanding financial aid, student loans, bills & payments, along with personal finances and budgeting

Using college technology, software & apps (log-ins, downloads, D2L, Navigate, Office 365 with Word and Excel, etc.)

Workforce development (ie, resumes, internships, job search & placement, employability skills)

Other support not previously listed

Sign and Submit

I certify the information given on this application is true and correct to the best of my knowledge. I hereby authorize TRIO Student Support Services to obtain my records or data pertinent to my participation in the program from College Admissions, Accessibility Services (if applicable), Financial Aid, Registrar, the National Student Clearinghouse, and my parent or contributor for the FAFSA. I also authorize the college or professional associated with it to access and release data for purposes of my academic success or TRIO project audit or evaluation. Photographs taken by my participation in TRIO activities may be used in TRIO publications. I understand this authorization may be revoked by me at any time through written or verbal communication.

To electronically sign this application, provide your signature using one of the available options. Note, "Simple Sign & Submit" may provide a brief delay before the signature box comes up on the screen.

Select signature type and then Submit Application button to proceed *

Please select a signature verification type.