Phone Number
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Format: (000) 000-0000.
Student ID #
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Name
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First Name
Last Name
This semester my goal(s) are...
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What steps do you plan to take that will help you achieve your goal(s)?
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During my time at West Virginia State University I hope to...
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What steps do you plan to take to help you achieve your goal(s)?
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After graduating West Virginia State University my goal is...
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What steps do you plan to take to help you achieve your goal(s)?
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Are you currently employed?
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Please Select
Yes
No
Other
How many hours per week do you work?
Where do you work?
Are you currently looking for employment?
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Yes
No
This semester I would like to... (Check all that apply)
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Participate in tutoring
Participate in cultural activities
Attend skill building workshops
Find a major and/or minor
Receive assistance with my FASFA
Develop a graduation plan
Prepare for graduate school
Explore careers
Develop a resume
Improve my grade point average
Improve my test taking skills
Improve my study skills
Improve my reading comprehension
Improve my writing skills
Improve my note taking skills
Reduce math/test anxiety
Improve my math skills
Improve my decision making skills
Improve my leadership skills
Improve my time management skills
Improve my financial literacy
Improve my job search skills
Meet people and/or make friends
Other
What would prevent you from achieving your academic goals this semester?
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Afraid to ask questions in class
Difficult Classes
Easily Distracted
Health Concerns
Lack Computer or Internet Access
Lack of Family Support
Lack of Money
Lack of Motivation
Lack of Self-Confidence
Lack of Technology Skills
Absent From Class
Tardy To Class
Procrastination
Test Anxiety
Unsure of the College Process
Working/Job
Other
Do you need tutoring this semester?
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Please Select
Yes
No
Undecided
Do you plan to graduate from WVSU?
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Please Select
Yes
No
Undecided
Other
Financial & Resource Assessment
Please complete the following to the best of your ability.
Name
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First Name
Last Name
Do you need grants/scholarships?
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Please Select
Yes
No
Other
Are you currently receiving loans to pay for school?
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Please Select
Yes
No
Other
Do you need help paying your utilities?
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Please Select
Yes
No
Do you have transportation to attend your classes?
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Please Select
Yes
No
By checking each box, you confirm that you have been informed of the requirements to be an active participate in TRIO Student Support Services.
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Signature
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