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.
Home Phone
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Gender:*

MaleFemaleNo Response/UnknownNonbinary/Other Gender
Ethnic Background:*

#1 American Indian or Alaskan Native#2 Asian#3 Black or African-American#4 Hispanic or Latino#5 White#6 Native Hawaiian or Other Pacific Islander#7 More than one race reported#0 No Response/Unknown
VERIFICATION OF ELIGIBILITY
Starting Semester at SXU*
Example: Fall 2024 or Spring 2024
Major*
Marital Status

SingleMarried/SeparatedDivorcedWidowed
Current College Grade*

First Year/ Never Attended (0-29 credit hours)First Year/Attended Before (0-29 credit hours)Second Year/Sophomore (30-59 credit hours)Third Year/Junior (60-89 credit hours)Fourth Year/Senior (90+ credit hours)Fifth Year/Other UndergraduateTransfer Student
Do/does your parent(s) (natural or adoptive) have a bachelor’s degree?*

YesNo
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.*

YesNo
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.*

YesNo
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?*

YesNo
Do you speak another language at home other than English?*

YesNo
If yes, what language?
Do you have a documented disability?*

YesNo
If yes, please describe.
Are you a veteran of the U.S Armed Forces?*

YesNo
Have you participated in another TRIO program?*

YesNo
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.

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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

L1L1/FGFGD/L1DD/L1/FG
Academic Need

Academic proficient testsFailing GradesLack academic preparedness for college level courseworkLimited English proficiencyLow high school gradesPredictive indicatorType option 7
Decision

AcceptedWaitlisted
Should be Empty:

TRIO-SSS Application

DEMOGRAPHIC INFORMATION

VERIFICATION OF ELIGIBILITY

ACADEMIC NEED

SELF-ASSESSMENT