Warrio
r ID #_____________________________
Completion of this form does not guarantee acceptance into the WSU TRIO Student Support Services
program, rather it officially indicates the student’s interest in applying for inclusion in the TRIO SSS
program. The TRIO SSS enrollment process requires the student to meet one-on-one with a TRIO SSS
advisor to review TRIO SSS services and participant responsibilities. Schedule a meeting with a TRIO SSS
Advisor at the time you submit this application form.
I am a U.S. citizen, a Permanent U.S. Resident, or hold Asylum/Refugee status in the U.S.
I am a First Generation college student (neither of my parents have a 4-year college degree.)
I meet federal low-income guidelines. (The term "low-income individual" means an individual
whose family's taxable income for the preceding year did not exceed 150 percent of the poverty
level amount. TRIO SSS staff will verify this based on your FAFSA)
I have a physical, psychological, and/or learning disability and have provided documentation
to and am registered with the WSU Access Services Office.
Name: _______________________________________________________________________________
Last Name First Name MI
Warrior ID: _______________________________ Star ID: ________________________________
Ho
me Address: ________________________________________________________________________
City: ___________________________________ State: _________________ Zip code: _______________
Lo
cal Address or WSU Hall and Room Number: _______________________________________________
City: ___________________________________ State: __________________ Zip code: ______________
Em
ail address: ______________________________________
Ho
me Phone Number: __________________________ Cell Phone Number________________________
Dat
e of Birth: __________________ Gender: ________________ Race/Ethnicity:___________________
Veter
an? Yes___ No___ Branch of Military Service _____________ Dates of Service________________
First enrollment at WSU: Fall ___ Spring ___ Summer___ Year: _________________________________
I h
ave chosen a major or minor area of study: Yes_____ No_____
My
Declared Major is: ______________________ My Declared Minor is: ________________________
My A
ssigned Faculty Advisor is: __________________________________________________________
En
rollment Status: Full-time_____ Part-time_____ Are you a parent? Yes_____ No_____
PL
EASE COMPLETE RESERVSE SIDE
Student Support Services (SSS)
Intake Application Form
