TRIO SSS 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 ineligible at this time.

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PERSONAL INFORMATION:

Last Name *

First Name *

Middle Name

Date of Birth *

School ID *

Cell Phone Number *

Email Address *

Gender Identification

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 *

Parent/Guardian #2 *

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 (9)

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

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 (15)

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.