TRiO SSS Application 2024-2025

TRiO 2024-2025

Student Support Services
Student Name*
T Number*
T00000000
Date of Birth*

MonthDayYear
Have you been enrolled in a TRIO program in the past? (For example: Talent Search or Upward Bound at SUU)*

YesNo
If Yes, please list all programs and the institutions where they took place.
Currently registered with the Disability Resource Center?*

YesNo
Household size reported on FAFSA:*
Example 3
Income level reported on FAFSA:*

$0 - $19,140$19,141 - $26,130$26,131 - $32,940$32,941 - $39,750$39,751 - $46,560$46,561 - $53,370$53,371 - $60,180$60,181 - $66,990$66,991 +
Are you a first-generation college student? (This means that neither of your parents have a 4-year bachelor's degree or higher)*

YesNo
Are you seeking a Bachelor's Degree?*

YesNo
Projected graduation date*

MonthDayYear
Class Standing*
Are you receiving Pell Grant funds?*

YesNo
Ethnic Origin: (Select all that apply)

American Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoWhite or CaucasianHawaiian Native or Pacific Islander
Preferred Contact Information (will be used by TRiO SSS)
Phone Number*
Email Address*
example@example.com
TRiO SSS services that I am interested in:

MentoringTutoringWorkshops & EventsGrant AidOther
Types of workshops & events you are interested in attending*
The student will not be considered active until all documentation has been received. The student will be notified via email regarding the acceptance into the program.

TRiO Student Support Services agrees to:
- Enroll each eligible student for services and explain the Student Support Services program along with the federal guidelines.
- Assess each individual student's need for services and assist them in developing an educational plan.
- Provide mentoring, tutoring services, and supplemental academic/financial aid advising.
- Offer workshops, activities, and events to help students explore educational and career opportunities.
Student agrees to:
- Meet with TRiO SSS Coordinator at least twice (2) per semester for advisement and progress updates.
- Engage with their TRiO SSS student mentor and attend at least one (1) activity, event, and/or workshop per semester.
- Utilize TRIO SSS tutoring services and maintain an attitude consistent with academic success.
- Complete TRiO SSS enrollment requirements. This includes meeting with a TRiO SSS Coordinator and providing the following: Copy of government issued ID. proof of income (FAFSA completion), completed intake form.
Driver's License

Please upload a photo of the front your Driver's License or State ID (not your SUU student ID).
Cancelof
I understand Student Support Services staff will have access to: (1) Transcripts; (2) Financial-Aid Records; and (3) Semester Grades. I agree to complete the enrollment requirements for SSS participation as outlined on the "Commitment Form". I attest that the information given here is accurate to the best of my knowledge.
Student Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

TRiO 2024-2025