Student Support Services Application

TRIO Student Support Services (SSS) is a grant program funded by the US Department of Education. We provide support, services and experiences to help students stay in college and graduate in a timely manner. Please answer all questions completely. We will check your eligibility and notify you if you are selected, placed on our waitlist or assigned to an Institutional Academic Success Coach.

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PERSONAL INFORMATION:

Last Name *

First Name *

Middle Name

Date of Birth *

School ID *

Cell Phone Number *

Email Address *

Gender *

Are you a US Citizen?

Yes *

If No, Registration Number Please

Have you previously participated in a TRIO Program (Educational Talent Search, Upward Bound, EOC or Student Support Services)?

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DEMOGRAPHICS:

Are you Hispanic or Latino/a?

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Race: Check all that apply

American Indian or Alaskan Native *

Asian *

Black or African American *

Caucasian / White *

Hispanic or Latino/a *

Native Hawaiian or Pacific Islander *

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VERIFICATION:

What is the highest level of education achieved by your parent(s)/guardian(s):

Parent/Guardian #1 *

Name of College Parent/Guardian #1 Graduated From If Applicable:

Parent/Guardian #2 *

Name of College Parent/Guardian #2 Graduated From If Applicable:

Do you have a documented disability? *

If yes, have you registered your disability with Graceland's Disability Services office?

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ACADEMIC NEED IDENTIFICATION - check all that apply

I have a High School or College GPA below 2.5 (1 or 7)

My ACT score is below 18 or SAT below 950 (2)

Please enter your score that you received on your test here:

I was homeschooled (14)

I have been out of school for 5 years or more (10)

I have a GED instead of a High School diploma (8)

I transferred from another college (13)

I have one or more F grades on my HS or college transcript (9)

I am a parent (5)

I am required to take Developmental classes (Discourse 1 with Lab or Intermediate Algebra) (14)

I have been in foster care or have a guardian appointed by the court (5)

English is not my first language (12)

I have been / am currently homeless (5)

I do not have a laptop or personal computer (14)

Other (11)

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Indicate services you would like to receive from the TRIO Student Support Services program/team. Check all that apply.

Academic Advising / Assistance with class selection

Career/ major exploration and/or decision making

Assistance navigating campus resources

Tutoring

Assistance in understanding or applying for financial aid

Assistance with technology and/or Brightspace

Support in transition/adjustment to college

Graduate school planning

Financial Literacy

Peer Mentoring / Support

Faculty or professional Mentoring / Support

Textbook library

Laptop assistance

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The above information is true and complete, to my knowledge. I understand it is confidential and will be used for intake purposes. Further, I release the following information to TRIO-Student Support Services to verify eligibility, determine appropriate services and to track academic progress and attendance: mid-term and final grades, transcripts/registration information, financial aid information, income information, transfer information, and communication with instructors/advisors.

I agree to participate in the STEPS TO SUCCESS 1 credit hour course each semester from the spring of my incoming year to the fall of my graduating year for a possible total of 6 semesters.

Providing my cell phone number enrolls me in the texting program that I can opt out of at any time by contacting staff. I understand completion of application does not guarantee acceptance to the TRIO-SSS program. Acceptance into the program is on a first come, first serve basis and based on eligibility criteria outlined by the Department of Education that funds the program.

Student Signature *

Please select a signature verification type.