FA 25 Participant Application Form

Fall 2025 TRIO Student Support Services Participant Application Form

Please complete this form in it's entirety. Missing information may cause your application to be denied.
Personal Information
MSU Student ID*
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Permanent Address
Street Address*
City*
State*
Zip Code*
Contact Information
Phone Number*
Alternate Phone Number*
MSU Email*
Personal Email*
Demographic Information
Gender*
Pronouns
Ethnic Origin (check all that apply)*

American Indian or Alaskan NativeAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or Pacific IslanderWhite (non-Hispanic)
Additional Information
How did you find out about TRIO SSS?*
Are you a US Citizen or Permanent Resident?*

YesNo
Have you served in the military or reserves?*

YesNo
Have you completed the FAFSA?*

YesNo
Have you previously participated in another TRIO program?*

YesNo
If so, which one(s) - check all that apply

TRIO Student Support ServicesUpward Bound/Upward Bound Math ScienceTalent SearchEducational Opportunity Center (EOC)
Eligibility Information

Participants must meet one or more of the eligibility criteria below
First Generation College Student: The term “first generation college student” means
1. An individual both of whose parents did not complete a baccalaureate (bachelor’s or 4-year college) degree, OR
2. In the case of any individual who regularly resided with and received support from only one parent, an individual whose only such parent did not complete a baccalaureate (bachelor’s or 4-year college) degree.
Under the above definition, Are you a “First Generation College Student?”*

YesNo
Students with Disabilities: Students with a documented physical, psychological, or learning disability also qualify for TRIO SSS.
Do you have a documented physical, psychological, or learning disability?*

YesNo
If you answered yes above, you must register with the MSU Resource Center for Persons with Disabilities (RCPD) and provide an accommodations letter OR submit a TRIO SSS Disability Verification Form (linked below).*

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Access our Disability Verification Form HERE.
Income Verification:

As a federally funded TRIO program, TRIO-SSS is required to provide documentation of your eligibility for our program to the U.S. Department of Education to meet TRIO regulations that two-thirds of the students in our program meet federal low-income guidelines.

To qualify, students must meet the income criteria based on the Federal TRIO Program's current-year low-income thresholds. As proof of income, please provide the following documentation:
- For DEPENDENT students: A copy of your parent or guardian’s federal tax return (1040 Form). Student must be listed on the tax return as a dependent.
- For INDEPENDENT students: A copy of your federal tax return (1040 Form).
If a tax return has not been filed, you may submit an Income Verification Form as an alternative.

Failure to provide the correct information may result in your application being denied.
Dependency Status: What is your dependency status?*

DependentIndependent
Household Size: How many people (including yourself)*
Please upload proof of income below:*

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Academic Need:
Educational Level (check all that apply)*

I was a part of a dual enrollment HS/College programI am a High School GraduateI am a GED GraduateI am a transfer studentI am an incoming MSU studentI am currently enrolled/actively taking classes at MSU
Areas you feel TRIO SSS can help with (check all that apply)*

Low college gradesLimited English proficiencyNeed for academic support to raise gradesLack of educational and/or career goalsLack of academic preparedness for college course workBeen out of the academic pipeline for 5 or more years
Academic Standing: What is your current GPA?*
Academic Plan: What is your current or intended major?*
Self Assessment:
What TRIO SSS services would you find beneficial (check all that apply)*

Academic Skills Coaching (Time Management, Study Skills, Test-Taking Strategies)Academic TutoringCareer Coaching & ExplorationGraduate School PreparationAcademic Advising/Peer MentoringFinancial Coaching EducationCultural Enrichment
Essay Questions:
Please attached your responses to the following prompts.
1. Please explain, in detail, your academic need for TRIO SSS and how you expect to support and enhance your academic and collegiate experience from becoming a participant in the program.
2. Please describe your career goals.
3. What do you see as your greatest challenges in achieving success at MSU and what are your strengths and resources that you will utilize to overcome these challenges?
Please upload your responses below. Include all responses in one file.*

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RELEASE OF INFORMATION
I hereby certify that the information provided is true to the best of my knowledge. I understand any false information given will result in the loss of the opportunity to participate.

I authorize the MSU TRIO SSS Program to collect information on my academic progress (including grades, credits, and transcripts) and financial aid status before and during my participation in SSS.

I understand that this information is confidential and used to assess my eligibility and participation in the TRIO SSS Program. My eligibility and financial aid status will be shared with the U.S. Department of Education as required. I confirm the accuracy of the information in this application and will provide verification if requested. I acknowledge that my personal information is protected under the Family Educational Rights and Privacy Act of 1974.

No one will have access to the information unless they work with or for the MSU SSS program or are authorized by me to see the information. Upon formal acceptance into the program, I grant permission for program representatives to have access to my official academic and financial records in order for SSS staff to assist me. Additionally, during my involvement in the SSS program, TRIO SSS staff may consult with various MSU offices and programs to secure and share the information pertinent to my participation in the program and overall collegiate success.

Finally, I give my permission to use photographs, quotes, and statements and/or print my first and last name in any and/or all publications for Michigan State University Student Support Services Program.
AFFIDAVIT OF TRUTH STATEMENT
The information provided on this form is, to the best of my knowledge, accurate and true.
Student Signature*

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Date*

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Date
Parent/Guardian Signature

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Date

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MSU Student ID 2
Name 2

First NameLast Name
Date 2

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Should be Empty:

Fall 2025 TRIO Student Support Services Participant Application Form

Personal Information

Permanent Address

Contact Information

Demographic Information

Additional Information

Eligibility Information

Academic Need:

Self Assessment:

Essay Questions:

RELEASE OF INFORMATION

AFFIDAVIT OF TRUTH STATEMENT