TRIO - SSS Application

TRIO-SSS Application

Please complete the entire form.
DEMOGRAPHIC INFORMATION
Name

First NameMiddle NameLast Name
SXU ID #
It's an 7 digit code on your Student ID
SXU Email Address
smith.j01@mymail.sxu.edu
Home Address Street
Apt.
Home Address City
Home Address State
Home Address ZIP Code
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth

MonthDayYear
Date
Gender:
Ethnic Background:
VERIFICATION OF ELIGIBILITY
Starting Semester at SXU
Example: Fall 2024 or Spring 2024
Major
Marital Status
Current College Grade
Do/does your parent(s) (natural or adoptive) have a bachelor’s degree?
At any time since age 13, were you declared homeless, a foster care youth or emancipated minor? If you answer yes, then you are an independent student.
Do you have children/dependents who receive more than half of their support from you? If you answer yes, then you are an independent student.
Please provide your parents’ annual taxable income. (Provide only your income if you are an independent student.) Federal regulations require verification of income status. You may fulfill this requirement by submitting your/your parent’s most recent income tax returns, signed financial aid application, income-based government document or the TRIO income document.
Number of people in your household including yourself.
Are you a citizen or a National of the United States?
Do you speak another language at home other than English?
If yes, what language?
Do you have a documented disability?
If yes, please describe.
Are you a veteran of the U.S Armed Forces?
Have you participated in another TRIO program?
If yes, which program?
ACADEMIC NEED
Last school attended
Last date of attendance

MonthDayYear
Date
High School attended
Last date of attendance

MonthDayYear
Date
High School GPA
College GPA
ACT or SAT Score
GED Score on a scale of....
SELF-ASSESSMENT
What types of support do you believe are essential for your success in college, and how can the TRIO program be of benefit to you?
I certify that the information presented on this application, especially income, is true and accurate to the best of my knowledge. I further understand that falsifying information on this form may result in immediate dismissal from the program. Please sign below.
Today's Date

MonthDayYear
Date
Thank you for applying! If you have any questions or need additional information, please email us at TRIO@sxu.edu or call our office at (773) 298-3342.
Case #
Classification
Academic Need
Decision
Should be Empty:

TRIO-SSS Application

DEMOGRAPHIC INFORMATION

VERIFICATION OF ELIGIBILITY

ACADEMIC NEED

SELF-ASSESSMENT