TRIO SSS Application

Thank you for your interest in our TRIO Student Support Services program. Please complete this application as thoroughly as possible.

Please note you need to be enrolled in classes in order to be considered for the program.

If you have any questions, please call the office at 479-788-7355.

General Information:

Last Name *

First Name *

Date of Birth *

Address *

Address 2

City *

State *

Zip *

Phone Number *

UAFS Email Address *

UAFS ID Number *

Race, American Indian or Alaskan Native *

Race, Asian *

Race, Hawaiian or other Native to Pacific Island *

Race, Hispanic *

Race, Black or African American *

Race, White *

Are you a US Citizen? *

Is English your primary (first) language? *

Do you have a documented disability? *

Academic Information:

What is your major? *

What support are you hoping to receive from Student Support Services?
(Select all that apply and add details if you wish.)

Academic coaching or study strategies

Tutoring or help in specific classes

Help staying organized or managing time

Guidance navigating college systems or resources

Financial aid or scholarship support

Career or major exploration

Support balancing school, work, and family

A supportive campus connection or advocate

Other:

Do any of the following academic or educational experiences apply to you?
(Check all that apply.)

I have earned failing or very low grades in one or more courses

My high school education did not fully prepare me for college-level work

I completed a high school equivalency (GED/HiSET) instead of a traditional diploma

I have been out of school for five or more years

I am unsure about my academic or career goals

I have struggled with reading, writing, math, or study skills

My ACT/SAT or placement test scores were lower than I hoped

My college GPA has been lower than required for good academic standing

My high school GPA was lower than average

English is not my primary language

I need academic support to improve or maintain my grades

Based on my background or experiences, I believe I may be at risk of academic difficulty

Other academic challenges:

Family Information:

Parent 1's highest education level *

Parent 2's highest education level *

Parent's Taxable Income (enter 0 if none, write N/A if file as independent student): *

Student Taxable Income (enter 0 if none): *

How many people live in your/your parent's household? *

What is your (student) marital status: *

Did you file as a dependent or independent student on FAFSA and/or taxes? *

Have you completed FAFSA? *

What financial aid are you currently receiving? *

How Did Your Hear About the SSS Program?

By submitting this application, I authorize the SSS program to obtain, copy, review, and discuss records including (but not limited to): high school transcript, other college transcripts, financial aid records, standardized test scores, course registrations, academic progress, final grades and transcripts, and disability documentation.

I authorize the use of my name and photograph to be published in SSS publications. I also certify the above information to be correct to the best of my knowledge.

I understand the completion of the application does not guarantee acceptance into the SSS program.

Provide Your E-Signature Below *

Signature Type: Simple Start Over

Signature: (Type in your full name)

I agree to the terms included.