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: ________________________________
me Address: ________________________________________________________________________
City: ___________________________________ State: _________________ Zip code: _______________
cal Address or WSU Hall and Room Number: _______________________________________________
City: ___________________________________ State: __________________ Zip code: ______________
ail address: ______________________________________
me Phone Number: __________________________ Cell Phone Number________________________
e of Birth: __________________ Gender: ________________ Race/Ethnicity:___________________
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_____
Declared Major is: ______________________ My Declared Minor is: ________________________
My A
ssigned Faculty Advisor is: __________________________________________________________
rollment Status: Full-time_____ Part-time_____ Are you a parent? Yes_____ No_____
Student Support Services (SSS)
Intake Application Form
ID #_____________________________
Acknowledgements: Please read each statement below and sign to indicate that you understand
each statement and give each permission.
I give permission for the WSU TRIO SSS staff to access information required for the purpose of
verifying my TRIO eligibility and supporting me academically as a TRIO SSS participant.
Office of Admissions
Financial Aid Services
Student Record Services
Access Services for students with disabilities
Faculty members regarding academic progress
I give permission for th
e above listed offices and WSU faculty to release information to WSU TRIO
SSS staff concerning my admission to WSU; my financial aid application and/or awards; my
academic records, including transcripts, academic progress reports and grades; relevant information
and accommodations (if applicable); course progress and instructor feedback.
I give the WSU TRIO SSS program permission to use any audio, video, or photographic materials
containing my voice and/or image for the purpose of education and promotion of the TRIO SSS
In signing this document, I commit to active participation in the WSU TRIO SSS program. I
acknowledge that I have read and understood each of the above listed statements and grant the
stated permissions. I further agree to fully participate in the TRIO Program and to comply with staff
Student Signature ______________________________________________ Date__________________
Please use this space to provide TRIO SSS Staff with any information that you believe would
be helpful for them to know about you.
Assigned TRIO Advisor:_____________________________________ Date:____________________
Intake Advisor (if different than assigned advisor):_________________________Date:___________