TRiO Student Support Services Application

Student ID

First Name

Last Name

Birthdate

CONTACT INFORMATION

Address

Country

Street

City

Region

Postal Code

Home or Mobile Phone Number

Your Albion College Email Address

EDUCATION HISTORY

Current Year in College:

Freshman

Sophomore

Junior

Senior

Current Albion College GPA

Major or Desired Major (if Undeclared)

Previous College(s) Attended

Which certification did you receive prior to college?

Diploma

GED

Are you a returning student? (Out of college more than 5 years)

Yes

No

This semester, I am/will be enrolled:

Full-time (3+ units)

Part-time (less than 3 units)

PROGRAM INVOLVEMENT

Have you previously participated in another TRiO program?

Yes

No

Are you a member of any other Albion College organizations? i.e. Briton Path, Smooth Transition

Yes

No

If yes, what is the name of the Albion College organization(s)?

Are/Were you an active member of the U.S Armed Forces?

Yes

No

ELIGIBILITY FOR SERVICES

Has your primary parent, caregiver, or guardian received a 4-year college degree?

Yes

No

Total number of people living in your household *Including Yourself

Will you or have you used accessibility services or accommodations while in school?

Yes

No

I don't know

Have you ever been in foster care or in court appointed guardianship?

Yes

No

As of today, Are you a displaced worker?

Yes

No

WHICH CATEGORIES OF FINANCIAL AID DO/WILL YOU RECEIVE?

Have you applied for Financial Aid (FAFSA) for the current academic year?

Yes

No

Do you know the type of financial aid you'll receive this year? *Check all that apply

How did you hear about TRiO SSS? *Check all that apply

Counselor / advisor at another college

Albion faculty or staff member outside of SSS

TRIO Mailing

SSS staff member or mentor

Friend / family member who is a participant

Which TRiO SSS Services are you interested in? *Check all that apply

If Other, Which TRiO SSS Service are you interested in?

Write a short paragraph explaining your academic need and other ways TRiO SSS will be helpful to you. Limit your response to 250 words.

Statement of Verification and Disclosure I attest that all the information I provided above is true to the best of knowledge. I give permission for SSS to verify the information disclosed on this form with Albion College Cutler Center for Student Success of Achievement, Office of Financial Aid, and the Office of Admissions. I understand that my acceptance into the TRiO SSS program will require my active participation and engagement until graduation. I understand that midterm grade/status reports will be collected on my behalf. I give my permission to use my likeness for promotional, recruitment and educational purposes.

I agree