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Home > Student Life > TRIO Student Support Services > TRIO Application

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TRIO Application

Term*
Name (First, Middle, Last)*
51�� Student ID*
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Last 4 of Social Secuirty #*
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Birthdate*
Month
Day
Year
Address while attending school*
Street Address City State ZIP Code
Cell Phone
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Alternate Phone
51�� Email Address*
Enter Email Confirm Email
Are you a citizen of the United States or permanent resident?*
- Yes
- No
This field is hidden when viewing the form
Are you of Hispanic or Latino origin?*
- Yes
- No
This field is hidden when viewing the form
Have you been a foster youth or homeless after the age of 13?*
- Yes
- No
This field is hidden when viewing the form
How would you best describe yourself?*
Mark all that apply
- American Indian/Alaska Native
- Asian
- Black/African American
- Native Hawaiian/Pacific Islander
- White
This field is hidden when viewing the form
Do you have a diagnosed disability?*
- Yes
- No
This field is hidden when viewing the form
If yes, check all that apply*
- Prefer Not to Disclose*
- Physical (mobility, chronic illness)
- Vision/Hearing
- Learning
- Psychological (Anxiety, ADHD, Depression, etc)
- Other
*If you prefer not to disclose your disability to TRIO, you can register with Disability Services and report your disability only to them.
Disability – Other*
Are you registered with 51�� Disability Services?*
- Yes
- No
- Not Yet
- Not Sure
Educational Information and Goals
Will you be a full-time student?*
(at least 12 credit hours per term)
- Yes
- No
Do you already have an Associate’s (2 year) or Bachelor’s (4 year) Degree?*
- Yes
- No
Will you graduate from 51�� within 3 years?*
- Yes
- No
Do you plan to transfer to a 4-year institution after earning your Associate’s (2 year) Degree?*
- Yes
- No
This field is hidden when viewing the form
Did you require any special accommodations in high school?*
(i.e. IEP or 504)
- Yes
- No
Does parent/guardian 1 have a Bachelor’s Degree (4 year) or higher?*
- Yes
- No
Does parent/guardian 2 have a Bachelor’s Degree (4 year) or higher?*
Please mark N/A if your primary custody remained with 1 parent or guardian
- Yes
- No
- N/A
Have you participated in a TRIO program previously?*
- Yes
- No
Have you submitted the FAFSA?*
- Yes
- No
What is your program of study at 51��?*
If you plan to transfer, what school are you leaning towards?
What is this highest degree you want to earn?*
- Diploma/Certificate
- Associate’s Degree
- Bachelor’s Degree
- Master’s or Ph.D
About You
What is your main reason for attending 51��?*
What do you believe will be your biggest academic struggle?*
What factors outside of school could negatively affect your performance? (i.e. Finances, Relationships, Work, Personal Factors/Habits)*
How many minutes is your commute? (avg. one-way)*
- I live on campus
- 10 minutes or less
- 11-20 minutes
- 21-30 minutes
- More than 30 minutes
This field is hidden when viewing the form
How many hours do you plan to work per week while attending college? (avg.)
- 0 – I don’t plan to work
- 1-10 hours per week
- 11-20 hours per week
- 21-30 hours per week
- 31-40 hours per week
- Over 40 hours per week
What are your current study habits? Is this an area of concern and why?*
Do you anticipate finances will be a source of concern?*
- Yes
- No
- Maybe
How do you plan to pay for costs not covered by financial aid? (i.e. tuition, fees, books, supplies, living expenses)*
What is your career goal?*
Enter Initials*
I grant the 51�� Financial Aid Office permission to provide Federal Tax Information to Student Support Service representatives for TRIO program eligibility.
51�� does not discriminate in employment or education. See /about/non-discrimination-statement/ for additional information.
Date*
MM slash DD slash YYYY

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