TRIO SSS/SSSTP Application
Name
First Name
Last Name
CCSU ID Number
CCSU E-Mail
example@example.com
Personal E-Mail
example@example.com
Phone Number
-
Area Code
Phone Number
Can we send you Texts?
Yes
No
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Which Gender do you Identify with?
Male
Female
Non-Binary
Prefer not to say
What Race/Ethnicity do you Identify with?
American Indian
Asian
Black/African Decent
Hispanic?Latin (o/a)
Native Hawaiian/ Pacific Islander
White
Are you currently enrolled at CCSU?
Yes
No
What is your current Academic Standing
Incoming First-Year at CCSU (not a transfer)
Sophomore
Junior
Senior
Transfer incoming CCSU Student
Have you ever participated in a TRiO Program
Yes
No
If so: Which Program
Upward Bound/ UBMS
Talent Search/ ETS
SSS
Educational Opportunity Centers
Doesn't Apply
Have you ever been/Are you associated with the Military
Yes
No
What is your intended Major? (Undeclared is an answer)
Have either of your parents graduated with a 4- year Degree? (Have they earned a bachelor's degree)
Yes
No
Have you ever been in foster care or in a court appointed guardianship?
Yes
No
Do you have a documented Disability/ 504 plan/ IEP?
Yes
No
Are you registered with the office of Student Disabilities Center at CCSU?
Yes
No
Not yet, but I plan to
Have you completed a FAFSA
Yes
No
Which SSS Program are you interested in?
Teacher Prep
Classic
What Services can TRIO assist you with? (Select all that apply)
Academic Advising
Financial Literacy/ Financial Aid
Student Success Workshops
Advocacy
Mentoring
Professional Development
Tutoring/Academic Assistance
What are you Academic Goals while attending CCSU?
What may get in the way of you achieving those goals?
How did you become interested in Joining TRIO?
The information provided on this form is to the best of my knowledge, accurate a true. I understand that by applying to TRIO SSS program, I authorize program staff to obtain records or data pertinent to my participation from other campus offices and / or public agencies such as financial aid and academic records. I authorize program staff to release information to the U.S. Department of Education for reporting services. I understand that I am not eligible to receive TRIO Sss program service until the application and interview process is complete.
I agree
I do NOT agree
Along with this form, your answer will be considered as your official statement on the permissions our office requests from you.
I Agree
I do NOT Agree
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