5. Do you have a documented learning and/or physical disability?
Yes No If yes, please submit documentation to Office of Accessibility (OA) [803-323-3290]
■ I give permission for the TRiO program to obtain i nformation from OA related to my
disability, including specific diagnosis and accommodations I may need.
_____________________________________________________
Signature and Date
6. Have you participated in other TRiO programs? Yes No
If yes, please indicate which program(s) and at which school ______________________________
Educational Talent Search
7. Are you: ■ A citizen or permanent resident of the United States? Yes No
■ A transfer student? Yes No
Previous College Name __________________________________
8. What year did you graduate from high school? _________________________
9. What is your major? (write "undecided" if appropriate)_______________________________
PARTICIPANT REQUIREMENTS
Students admitted into the TRiO program must actively pursue an undergraduate degree at Winthrop and must adhere
to all policies and requirements set forth by the TRiO program. If admitted to TRiO, I understand that I must:
1. BE SERIOUS ABOUT MY SUCCESS!
2. Remain enrolled as a full-time student and strive to graduate from Winthrop University within 6 years.
3. Be a participant of the TRiO program during my entire enrollment at Winthrop.
4. Attend tutoring sessions, appointments with my Academic Counselor, and other services as required.
5. I further understand that I can lose my place in TRiO and all privileges associated with participation if I
fail to do any of the above after being admitted.
I hereby authorize program staff to access additional information relating to my academics, financial need, and disability so
that a determination can be made about my eligibility for this program and to monitor my academic progress (for example,
Offices of Financial Aid, Accessibility, Records and Registration, etc). If selected for participation, I further authorize the staff
to make changes to my schedule to accommodate a TRiO ACAD section, and to release my name, photo, and academic
performance on newsletters, brochures, webpage, press releases and letters, and with Winthrop faculty/staff, so that my family,
faculty, and fellow students can be kept informed of my progress. Winthrop’s Office of Alumni Relations will also be
provided with my name upon graduation. All of the information contained above is true to the best of my knowledge.
**Please Note: If admitted, TRiO staff will make changes to your schedule to enroll you in a TRiO-specific
ACAD101 course. All effort will be made to minimize changes to class times.
____________________________________________________ _______________________
Student Signature Date
For full consideration, please complete and return by Wednesday, July 8
th
to:
TRiO SSS Program, 102 Dinkins Hall, Winthrop University, Rock Hill, SC 29733
Student Support Services is a federal TRiO program funded by the U.S. Department of Education. Acceptance into the
program is contingent upon meeting eligibility criteria and space availability.
