TRIO/ Student Support Service Program Application
Applications will be screened and eligible candidates will be contacted to schedule an intake appointment. Please note that you will have to provide yours or your parents' income verification (Tax form, FAFSA copy, and/or other) and Student ID card on the day of your appointment.
DISCLAIMER: Submission of an application does not guarantee admission to the program.
Email address *
Full Name *
Your answer
Student ID *
Your answer
Address *
Your answer
Contact Number *
Your answer
Date of Birth *
Gender *
Race: Please select the racial category or categories with which you most closely identify by choosing the appropriate box. (Check as many as apply) : *
Ethnicity: Are you Hispanic or Latino? (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.) *
Marital Status *
Check the following as they apply to you: *
U.S. Citizen or Permanent Resident
Financial Aid Recipient
Filed 2017 Income Tax
Receive services from Disabled Students Program and Services (DSPS)
Single Parent
Independent Student (24 years of age or older, married, have children, veteran filed status, orphans or ward of the court)
Family Size (in your household): *
Your answer
Taxable Income $ *
Your answer
What is your parents' educational background? *
Did not graduate from high school
Graduated from high school
Obtained an associate's (2 year) degree
Obtained a bachelor's (4 year) degree
Obtained a master's degree
Obtained a doctorate degree
Your natural/adoptive/step father
Your natural/adoptive/step mother
Units Enrolled *
Your answer
Major *
Your answer
Current Class Level *
Please check the services you are interested in receiving (Check all that apply) : *
Educational Plans (Check all that apply) : *
Are you in any of the following campus programs (Check all that apply) : *
A copy of your responses will be emailed to the address you provided.
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