Thank you for your interest in the WSU Tech TRIO Student Support Services program! 

Please complete this application as thoroughly as possible.  You cannot save and restart this application.  You may want to review the included items, take some time to make notes and gather the required documents, and then return to submit your application. 

If you have any questions, please call our office at (316)512-7347; email us at trio@wsutech.edu; or stop by our office at the WSU South location room E102.
Student Information:
First Name *
Middle Name *
Last Name *
Social Security Number *
School ID *
Date of Birth *
Cell Phone Number *
Home Phone Number *
Personal Email *
Mailing Address *
City *
State *
Zip Code *
Gender *
Marital Status *
U.S. Citizen/Permanent Resident
Race / Ethnic Background (Select One)
American Indian or Alaskan Native
Asian
Black or African American
Hawaiian or other Native to Pacific Island
Hispanic/Latino/a
White or Caucasian
Identify as 2 or more
Education
High School Graduate
High School
High School City/State
High School Year Graduated
GED Recipient
GED Score
GED City/State Where Earned
GED Month/Year Earned
Other Colleges/Universities/Technical School Attended *
Have you taken any WSU Tech classes before applying to our program? *
When was/will be your first semester at WSU Tech
While attending WSU Tech, do you plan to enroll (Full-Time/Part-Time) *
Major *
Career Interest *
Do you plan to graduate from WSU Tech? (If Yes, please include anticipated graduation date) *
Do you plan to transfer to a 4-year college/university? *
What is the highest degree you would like to receive? (AA,BA, MA, PhD) *
Have you ever participated in other TRIO programs? *
First-Generation Eligibility
Did your FATHER/guardian graduate from a 4-year college or university? *
Did your MOTHER/guardian graduate from a 4-year college or university? *
Disability Eligibility
Do you have a documented physical/mental/learning disability (optional)?
Income Eligibility
Will be/currently receiving financial aid through WSU Tech? *
Do you qualify for the Pell Grant? *

How Can WSU Tech TRIO SSS Help You Succeed In College?

(Type an "X"  next to all the services that interest you)
Advising & Counseling
Academic Advising/Degree Planning
FAFSA Assistance
Career Counseling
Personal Counseling
Academic Support/Instruction
Math Tutoring
Reading Tutoring
Writing Tutoring
ESL (English as a Second Language)
Other Classes
Library Resources
Resume/Cover Letter/Interview Prep
Computer Applications
Time Management
Transfer Planning
College Information
College Application Assistance
College Visits
Scholarship Search & Applications
Workshops
Overcoming Test Anxiety/Stress Management
Note-taking Tips
Improving Communication Skills/Relationships
Building Cultural Competence
How To Write An Effective Paper
Time Management & Organization
Money Management (saving, budgeting, etc.)
Leadership Skills
How To Use A Graphing Calculator
Additional Questions
1. Why are you interested in joining TRIO Student Support Services? *
2. What obstacles may affect your academic goals? (Mark an "X" next to all that apply.)
Money Problems
Depression
Health Concerns (my own)
Problems At Home
Easily Distracted
Poor Study Skills
Single Parent
Lack Of Family Support
Homelessness
Time Needed For Job
Anxiety/Stress
Family Medical Problems
Alcohol/Drub Problems
Afraid To Speak In Class (shy)
Bad Grades
Difficulties With Childcare
Transportation
What are your long-term academic goals? *
What are your long-term career goals? *
What are your long-term personal goals? *
How did you find out about WSU Tech TRIO Student Support Services? *

Statement of Agreement and Consent

To the best of my knowledge, all information provided on this application is true and complete. I understand that the WSU Tech TRIO Student Support Services program will use the data provided on this form to assist in determining eligibility and all information will be kept confidential.  I understand that WSU Tech TRIO Student Support Services has eligibility requirements and a limited number of openings.  I understand that my application does not guarantee acceptance into the WSU Tech TRIO Student Support Services program.

I authorize WSU Tech TRIO Student Support Services to gather my high school and college transcripts, placement scores, FAFSA and scholarship information, disability documentation, ACT scores, and other necessary information in order to provide the services I have requested, and to make reports to the U.S. Department of Education for the re-funding of this program.  I also authorize WSU Tech TRIO Student Support Services to obtain periodic reports from my instructors regarding my academic progress for courses in which I am enrolled, as well as obtain college enrollment and degree information from my WSU Tech academic advisor. I understand that all information will be kept confidential and will be used for the following specified purposes:  student demographic data and record keeping, program evaluation, needs assessment, federal reporting, and other administrative purposes. 

I agree that if I am accepted into the WSU Tech TRIO Student Support Services program, the staff may use photographs, quotes, academic accomplishments, statements and/or my first and last name in any and/or all publications and/or webpages of the WSU Tech TRIO Student Support Services program.

I also understand as a participant of WSU Tech TRIO Student Support Services I am expected to represent a positive image of the program and WSU Tech. Any action by program participants which create a negative perception of WSU Tech TRIO Student Support Services and/or WSU Tech will not be tolerated.  These incidents will be reviewed on a case-by-case basis and can result in program participants being removed from the WSU Tech TRIO Student Support Services program.

Applications will be held for one year from date of application.  Please reapply at that time.

I have read and agree with the Statement of Agreement and Consent.
Student Signature (type full name) *