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TRIO Application
RELATED LINKS
Eligibility and How to Apply
Services Provided
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Trio
TRIO Application
Fill out the form below to apply for TRIO assistance.
Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Student I.D. Number (8000#####)
*
Address
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Home Phone
(e.g. xxx-xxx-xxxx)
Cell Phone
*
Email
*
Date of Birth
Ethnicity: Do you consider yourself to be Hispanic or Latinx?
Yes
No
Race: Please check all that apply
*
American Indian / Alaskan Native
Hispanic / Latinx
White
Black or African-American
Native Hawaiian/Pacific Islander
Asian
Marital Status
Married
Single
Citizenship
U.S. Citizen
Eligible Non-Citizen
Neither
What is your current class standing at Western?
*
Freshman (0-29 credits)
Sophomore (30-59 credits)
Junior (60-89 credits)
Senior (90+ credits)
Post Baccalaureate
Select of one of the following
First semester attending Western:
Fall
Spring
Summer
Year:
Do you plan on completing a 4-year (Bachelor's) degree?
*
Yes
No
Do you have college credits that you will be transferring in from either another college or high school?
*
Another College (transfer credits)
High School (AP or dual credits)
Neither
Have you served as a member of the United States armed forces?
*
Yes
No
Are you a spouse or dependent of someone who has served in the US armed forces?
*
Yes
No
Have you participated in Upward Bound, Talent Search, or Gear Up?
*
Upward Bound
Talent Search
Gear Up
None
Did either of your parents or legal guardians complete a four-year bachelor’s degree before your 18th birthday?
*
Yes
No
Do you have a documented disability? (Physical/Learning/Emotional)
*
Yes
No
Agree to terms
*
I Agree
I certify that the information on this application is accurate and complete to the best of my knowledge. I understand that falsification of this information constitutes fraud. I authorize TRiO Student Support Services to obtain any information from my educational and financial records that may be pertinent to my participation in the program (i.e. transcripts, ACT/SAT scores, grades, etc.). I understand The Department of Education requires social security number reporting as a condition for TRiO participation, and that my SSN will remain private and confidential. I authorize TRiO Student Support Services to include my photograph in my file and use images of me for program and publicity purposes. *
Digital Signature
*
Please type your full name as your digital signature
Date
*
Email
Submit