• TRIO STUDENT SUPPORT SERVICES APPLICATION FORM.

    Welcome! TRIO SSS program at Simpson University is thrilled to receive your application. After submission, please allow 2-5 business days for us to review your application and get back to you. Please allocate 5 to 30 minutes of your time to complete this document.

    To submit your application, please fill out the online TRIO SSS application form and provide all the necessary information.

    If you encounter any issues or need assistance, please don’t hesitate to reach out to us. You can email us at trio@simpsonu.edu or call us at 530.226.4166 or 530.226.4537.

    Remember to fill in the signature fields where prompted. Thank you for your interest in the TRIO SSS program! 

     

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    Introduction:

    Who is TRIO?

    Your goal of earning your college degree will take a lot of dedication and determination but you don’t have to go it alone. Simpson University’s TRIO Student Support Services (SSS) Program is here to help you accomplish your dream!

    We are fully funded by the U. S. Department of Education to help students who are first-generation, students with low-income status and/or students who have disabilities. These students are U.S. citizens/permanent residents. TRIO is here to help you navigate college education succesfully by providing academic and personal support.

    By completing and signing this document, you allow us to certify your eligibility in at least one of the qualifying areas to meet federal regulations.

    Dear Red Hawk,

    TRIO SSS Poem

  • Student Information Section

  • Date of Birth*
     - -
  • Housing Status*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Sex at Birth*

  • Eligibility criteria

  • Ethnicity*
  • Hispanic or Latino*
  • Please Check All that Apply*
  • Veteran Status*
  • Prior TRIO/College and Career Readiness Program Participation*
  • TRIO/College and Career Readiness Program*

  • Parent Information

    Please indicate the highest level of education completed by the natural or adoptive parent(s) you lived with prior to age 18
  • Parent 1 Highest Education Level - Please Check All that Apply*
  • Parent 2 Highest Education Level - Please Check All that Apply*

  • Financial Aid and Income Verification

  • Financial Aid Awarded*
  • Check the reason(s)*
  • Financial Aid Types Received*
  • Dependent Student*
  • Format: (000) 000-0000.
  • Do you authorize Simpson University TRIO SSS Program to ascertain income eligibility using the Financial Aid Office?*
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  • School Prompts

  • Academic Program*
  • Participates in Athletics*

  • Learning You

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  • Student Support Services Needs - Please check all that apply (Where can TRIO serve you best?)*
  • Academic Readiness - Please check all that apply (Where can TRIO serve you best?)*
  • Career & Educational Planning - Please check all that apply (Where can TRIO serve you best?)*
  • Financial Readiness - Please check all that apply (Where can TRIO serve you best?)*
  • College Knowledge & Campus Navigation - Please check all that apply (Where can TRIO serve you best?)
  • Personal & Social Development - Please check all that apply (Where can TRIO serve you best?)
  • Health, Wellness & Support Services - Please check all that apply (Where can TRIO serve you best?)
  • Family & Environmental Factors - Please check all that apply (Where can TRIO serve you best?)
  • Handedness - for Accommodations and Ergonomics

  • Student Participation Agreement

  • As a TRIO Student Support Services (SSS) Participant, we ask that you make a commitment to yourself and the TRIO program, so you may fully benefit from the services TRIO has to offer. Your participation in the TRIO SSS Program will support successful progress toward timely degree completion and the attainment of post-graduate goals.

    Our staff will work closely with you to provide comprehensive services. As a participant – you will be responsible for adhering to the following recommendations for success. Your affixed signature at the bottom of this page signifies that you agree to all the recommendations below. Failure to adhere to the below policies and procedures will result in denial of academic, career, and educational services. The SSS Program will email you a copy of this agreement.

     

  • Authorization, Consent, and Certification

    By signing this application, I acknowledge and agree to the following:

    • In accordance with the Privacy Act of 1974 (Public Law No. 93-579, 5 U.S.C. §552a), the U.S. Department of Education is authorized to collect and maintain information for the administration of the Student Support Services (TRIO SSS) Program under Title IV of the Higher Education Act of 1965, as amended. Information collected through this application will be used to determine eligibility, provide services, monitor academic progress, evaluate program effectiveness, and fulfill federal reporting requirements.
    • I authorize the TRIO Student Support Services (TRIO SSS) Program at Simpson University to review and obtain information necessary to determine my eligibility and support my academic success, including admissions records, placement scores, academic records, transcripts, grade point average, demographic information, financial aid reports, and other educational records.
    • I understand that all information collected by TRIO SSS, including information provided on this application and information obtained from educational institutions and government agencies, will be maintained in confidence and used for program administration, student support, assessment, evaluation, and reporting to the U.S. Department of Education.
    • I authorize the release and exchange of academic, educational, and financial aid information between TRIO SSS, educational institutions, and federal agencies as necessary to assess eligibility, monitor academic progress, develop and update academic and career plans, track degree completion, document program participation, and meet federal reporting requirements.
    • I consent to the disclosure of personally identifiable information from my education records, as permitted under FERPA, to TRIO SSS staff for educational and program purposes, including confirmation of postsecondary enrollment and degree attainment through the National Student Clearinghouse StudentTracker service.
    • I authorize TRIO SSS staff to communicate with me through phone calls, emails, text messages, and other appropriate methods for consultation, guidance, advising, program updates, and follow-up regarding my educational goals and participation in the program.
    • I grant permission for TRIO SSS staff to share and discuss information related to my academic, personal, and educational progress with appropriate school personnel, faculty, staff, parents, guardians, or other individuals, when applicable and deemed necessary to support my success.
    • I authorize TRIO SSS to monitor my academic progress and obtain, exchange, and maintain copies of reports, records, and other pertinent documents necessary to provide services and support my educational goals.
    • I grant permission to TRIO SSS to take, use, reproduce, and publish photographs, video recordings, written work, testimonials, achievements, awards, accomplishments, comments, and similar materials related to my participation in the program for educational, promotional, recruitment, public information, reporting, and program outreach purposes.
    • I understand that TRIO SSS staff may contact me periodically while I am enrolled in the program and after I exit the program to evaluate educational outcomes, update program records, support alumni engagement activities, and fulfill federal reporting requirements.
    • Unless revoked in writing where permitted by law, these authorizations will remain effective while I am enrolled in the Simpson University TRIO Student Support Services Program and, when applicable, for up to six (6) years following admission to the program for reporting and compliance purposes.
    • By signing or electronically submitting this application, I certify under penalty of perjury that all information provided is true, accurate, and complete to the best of my knowledge, and that any supporting documentation submitted to verify program eligibility is authentic and genuine. I understand that acceptance into the program is contingent upon verification of eligibility and program requirements.
  • Date*
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  • Time*
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