TRIO Online Application

Gain all the benefits of being in TRIO-Student Support Services by applying today! As an active participant you will have access to an advisor, peer mentors, graduate school visits, cultural experiences, community engagement, and so much more. Applications are accepted on a rolling basis.

Contact Information:

First Name:       M.I.:
Last Name:
Date of Birth:       UD Student ID:
Phone:       E-Mail:

 Local Address

 

 Permanent Address

 Street:      Street:  
 City:      City:  
 State:      State:  
 Zip Code:      Zip Code:  

Would you like to receive program text message updates?

     Yes      No

Are you a U.S. Citizen or permanent resident?

     Yes      No
         If not, please state your current status:

Please check your racial/ethnic background:

     American Indian/Alaskan Native
     Asian
     African-American
     Hispanic or Latino
     White
     Native Hawaiian or other Pacific Islander
     Other:


FIRST-GENERATION QUALIFICATIONS

Complete only for parent(s) or guardian(s) that you primarily lived with while attending high school.

Have either of your parents/guardians received a bachelor degree?      Yes      No
     If yes, please specify which parent/guardian:

DISABILITY QUALIFICATIONS

Student Disability Status (Voluntary)
Do you have a disability?      Yes      No     Unsure
    If yes, have you met with the University Learning Support Services Coordinator regarding accommodations?      Yes      No

LOW-INCOME QUALIFICATIONS

Have you applied for Financial Aid?      Yes      No
If yes, did you receive a Pell Grant?      Yes      No

EDUCATIONAL INFORMATION

What is your academic classification for the upcoming school year?
     Freshman      Sophomore      Junior      Senior      Other/Unsure

Did you transfer to UD from another college/university?      Yes      No
     If yes, where did you transfer from?

Were you a TRIO participant at another school (Talent Search, Upward Bound, SSS)?
     Yes      No

When did/will you start at the University of Dubuque?
    Semester: Year:

What is your intended major(s)?

Attendance at UD?      Full Time      Part Time

What is your expected graduation date from UD?

What are your career goals? What type of job are you hoping for?

Do you intend to go to Graduate School?      Yes      No
     If yes, what program?

Which of the following TRIO-SSS services will you use?

     Tutoring
     Financial Literacy
     Choosing a major or career
     Managing time/organization
     Managing stress
     Test taking and study strategies
     Registration for classes
     Academic Advising
     Writing papers
     Budgeting/personal finances
     Understanding degree requirements
     Setting and achieving goals

How did you hear about TRIO?

     ASC or TRIO-SSS Staff
     Admission Counselor
     Website
     TRIO-SSS Student Partipant
     Other UD Faculty/Staff
     Other


I understand that completion of this application does not constitute acceptance into the TRIO-Student Support Services program. I also understand that if I am accepted, I will be assigned to a TRIO-SSS Advisor, will be encouraged to take advantage of tutoring, academic advising and workshops and participate in educational and cultural opportunities. Program participation is necessary to be eligible for a TRIO Scholarship.

I hereby give permission for TRIO-SSS staff to disclose and receive information concerning the nature of my eligibility and information concerning my academic progress on an as-needed basis with appropriate faculty and staff at the University of Dubuque. I also give TRIO-SSS staff permission to photograph me for promotional purposes, to view and receive any and all financial aid information, as well as receive information from past, current, and future schools. By initialing and submitting this application I am signifying that I have read and understood this application, and that what I have reported is truthful and accurate.

Initials:    Date: