TRIO SSS Student Success Plan

Phone Number*
Student ID #*
Name*

First NameLast Name
This semester my goal(s) are...*
What steps do you plan to take that will help you achieve your goal(s)?*
During my time at West Virginia State University I hope to...*
What steps do you plan to take to help you achieve your goal(s)?*
After graduating West Virginia State University my goal is...*
What steps do you plan to take to help you achieve your goal(s)?*
Are you currently employed?*
How many hours per week do you work?
Where do you work?
Are you currently looking for employment?*

YesNo
This semester I would like to... (Check all that apply)*

Participate in tutoringParticipate in cultural activitiesAttend skill building workshopsFind a major and/or minorReceive assistance with my FASFADevelop a graduation planPrepare for graduate schoolExplore careersDevelop a resumeImprove my grade point averageImprove my test taking skillsImprove my study skillsImprove my reading comprehensionImprove my writing skillsImprove my note taking skillsReduce math/test anxietyImprove my math skillsImprove my decision making skillsImprove my leadership skillsImprove my time management skillsImprove my financial literacyImprove my job search skillsMeet people and/or make friendsOther
What would prevent you from achieving your academic goals this semester?*

Afraid to ask questions in classDifficult ClassesEasily DistractedHealth ConcernsLack Computer or Internet AccessLack of Family SupportLack of MoneyLack of MotivationLack of Self-ConfidenceLack of Technology SkillsAbsent From ClassTardy To ClassProcrastinationTest AnxietyUnsure of the College ProcessWorking/JobOther
Do you need tutoring this semester?*
Do you plan to graduate from WVSU?*
Financial & Resource Assessment

Please complete the following to the best of your ability.
Name*

First NameLast Name
Do you need grants/scholarships?*
Are you currently receiving loans to pay for school?*
Do you need help paying your utilities?*
Do you have transportation to attend your classes?*
By checking each box, you confirm that you have been informed of the requirements to be an active participate in TRIO Student Support Services.*
Signature*

Clear
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Financial & Resource Assessment