First Name *

Last Name *

Email *

Phone *

Student ID (G#) *

What are your career interests? *

What are you planning to major in? *

Are you interested in working in K-12 Education? *
- Select Option Yes No

Check ALL areas in which you feel SSS staff can assist you in the future. *
Academic Support & Scheduling Assistance
Budgeting and Money Management
Career Counseling
Graduate School Counseling
Motivation & Personal Counseling
Scholarship & Financial Aid Information
Secondary Admission Assistance
Study Abroad Advising
Study Skills & Time Management
Tutoring & Academic Support

How did you hear about TRIO? *

By submitting this form, I agree that I have read and understand the following:

• I understand that TRIO will collect information about my participation in the program for the purposes of developing statistical data, evaluating program efficacy, and assessing my academic and/or career needs.
• I authorize the TRIO program(s) to gather information concerning my academic record from the Registrar’s Office, and my FAFSA from the Financial Aid Office prior to my participation and throughout my involvement in TRIO. I understand that this information is used to assist in the determination of my eligibility for the TRIO program and it will be held strictly confidential.
• I understand I am giving permission to TRIO staff and financial aid staff to access my records and financial aid information in order to determine if I meet federal income guidelines.