Rev 07/20
Student Support Services, a TRIO Program, is funded by the U.S. Department of Education.
1. ONLY COMPLETE APPLICATIONS WILL BE ACCEPTED, including required signatures.
2. Submit a copy of all unofficial college transcripts, financial award letter, completed FAFSA or income tax return, and photocopy of
permanent resident card if applicable. If you have never attended college before, please submit a copy of your high school transcript.
3. Return to TRIO Student Support Services office (Wenatchee: Wells Hall 1074) or email to
4. TRIO SSS will contact student within 5-7 business days.
5. Eligible students will be invited for an intake interview/orientation (60 minute appointment).
Personal Information
___Male ___Female
Last Name
First Name
_________________________________ _________________________________
SSN# SID# (WVC Student ID#)
Date of Birth
Mailing Address
Phone Texting ok? ___Yes ___No
WVC Student Email
Alternative Email
Are you a U.S. citizen? ___Yes ___No
Expiration Date: __________________________
Is English your first language? ___Yes ___No
Other languages you speak fluently? _____________________
Have you ever been in foster care or were a ward of the court?
___Yes ___No
Are you a U.S. Veteran (Have you served in the U.S. Military)?
___Yes ___No
Have you been involved with TRIO at any other institution?
___Yes ___No
Do you identify your race as: Native American/Alaskan Native ___Yes ___No
(Check all that apply if multiracial) Asian American ___Yes ___No
Black or African American ___Yes ___No
Caucasian or European American ___Yes ___No
Native Hawaiian or other Pacific Islander ___Yes ___No
Do you identify your ethnicity as: Hispanic or Latinx/a/o ___Yes ___No
Program Eligibility
Did either of your parents/guardians graduate from a 4-year college or university?
___Yes ___No
Do you have a documented disability?
___Yes ___No
If yes, have you documented it with the WVC Student Access Coordinator?
___Yes ___No
Financial Information
___Yes ___No
___Yes ___No
Household Size
Taxable Income
Are you currently receiving Financial Aid through WVC?
Did you or your family file a tax return for the previous calendar year?
Review chart for federal low-income guidelines. For families with more than eight
members, add $6,720 for each additional family member.
Number of people in your household, including yourself: ________
Your family’s taxable income for last year: ________
For income tax purposes, are you? ___Dependent ___Independent
What is your marital status? ___Single ___Married ___Other: _________________
Do you have an undergraduate degree?
Yes___ ___No
Did you receive your high school diploma or GED?
Yes___ ___No
Year received: ______
What are your educational goals?
___Certificate ___Associate’s Degree ___Transfer to 4-Year ___Undecided
Area of StudyExpected graduation date (quarter/year): _______________ __________________________________
What is your current grade level?
New Student (no college credits completed)
Freshman (completed less than 45 college-level credits)
Sophomore (completed at least 45 college-level credits)
Current enrollment status:
Part-time Student (less than 12 credits per quarter)
Full-time Student (12 credits or more per quarter)
Have you attended other colleges? __Yes __No If yes, which one(s)? ______________________________________________
*Please remember to attach unofficial transcripts for all colleges previously attended.
Student Needs Assessment - Check all that apply
Academic Advising, Course Selection, &
Financial Literacy
Academic Support & Instruction
Individualized Guidance & Workshops
___Major & career information
___Overcoming text anxiety/stress
___Personal counseling referrals
___Job search skills
___Note-taking tips
___Improving confidence/assertiveness
___Academic advising/degree planning
___Presentations & public speaking
___Procrastination & goal-setting
___Transfer school information & advising
___Time management; prioritizing tasks
___Developing leadership skills
___Financial aid application assistance
___College-level reading and writing
___Improving communication & relationships
___Scholarship search & application help
___Test-taking tips; self-testing
___Managing family or work responsibilities
___Other concern: _____________________
___Other concern: _____________________
___Other concern: _____________________
Short Answer Response Use the space below to answer. Attach additional pages if necessary.
Q. How will TRIO SSS help you accomplish your academic goals? From the list above, what is your greatest need?
Affidavit of Truth Statement
The information provided on this form is, to the best of my knowledge, accurate and true.
Applicant’s Name (Please Print)
Applicant’s Signature
Rev 07/20
Affidavit of Truth Statement
The information provided on this form is, to the best of my knowledge, accurate and true.
Applicant’s Name (Please Print) Applicant’s Signature Date
Internal Use
Academic Need
Diagnostic tests High School equivalency Lack of academic preparedness Predictive indicator Failing grades
Low High School Grades Limited English proficiency Low College Grades Lack of education and/or career goals
Low Admission test scores Out of academic pipeline for 5 or more years Other _________________________________
First Generation Low Income Disability
Cohort _____________
Institution Entry Date ____/______/______
Program Entry Level 1
Year, Never Attended 1
Year, Attended Before 2
Year Sophomore (CLVL Credits _______)
Program Entry Enroll Less than ½ time ½ Time ¾ Time Full Time
Program Entry Date ____/______/______
Compass Scores Write _____ Read _____ Math _____
LASSI Scores
Anxiety Attention Motivation Concentration Self-Test Study Aids
Main Idea
Skill: Cleared
Recommended Required
Will: Cleared Recommended Required Self-regulation: Cleared Recommended Required
Date of first service ____/_____/______
Financial Aid Received ____________
Rev 07/20