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  • PRAIRIE STATE COLLEGE

    STUDENT SUPPORT SERVICES PARTICIPANT APPLICATION

    PLEASE ANSWER QUESTIONS COMPLETELY

    Student Support Services
    202 South Halsted Street
    Chicago Heights, IL 60471
    (708) 709-3500

    TRIO Student Support Services is fully funded by the U.S. Department of Education.

    • Step 1: Student Contact Information 
    • Student Demographic Information 
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    • Step 3: Student Citizenship Information 
    • Step 4: First Generation Status Information 
    • Step 5: Student Dependency Information 
    • **PLEASE SKIP THIS SECTION IF YOU ARE 24 YEARS OLD OR OLDER**

    • Step 6: Student Financial 
    • If you are at least 24yrs old OR answered "yes" to any of the questions in Step 5 please answer the following questions based on your personal financial information. If you are under 24yrs old and answered "no" to all of the questions in Step 5 YOUR PARENTS must provide the following information.

    • Step 7: Student / Parent Verification 
    • By signing this application, I attest that all the information on this application is true and accurate. Moreover, I authorize the release of the student's official academic records to Student Support Services for educational purposes including referral for financial assistance including, but not limited to scholarships, fellowships, work study, and federal financial aid.

    • Clear
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    • Clear
    • *Parent / Legal Guardian Signature is required if any parent/legal guardian information is included in Step 6

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    • Student Participant Agreement Form 
    • Prairie State College
      Student Participant Agreement Form
      TRIO Student Support Services

      By electing to participate in TRIO/Student Support Services, I agree to full participation as follows:

      1. I will meet with my SSS advisor at least three times each semester that I am enrolled at PSC, or more as identified by my advisor throughout the school year.
      2. I will attend class(es).
      3. I will ask for educational support as soon as my grade falls below a "C" in any course.
      4. I will attend scheduled meetings with SSS staff or will contact SSS staff to reschedule.
      5. I will attend all scheduled tutoring sessions funded by the program, or will cancel by calling the TRIO Center at least 24-hours in advance.
      6. I will complete and submit all required financial aid forms on time as required.
      7. I will participate in appropriate SSS activities whenever possible.
      8. I release authorization for the SSS program to request any and all academic and non-academic documents related to my academic progress.
      9. I agree to allow the SSS program to add my Phone # to participant list to receive text messages. If no cell phone, please check box. Participants agree to inform program when phone number or address change.
    • If I do not comply with Items 1-8 above I might not be entitled to receive those services reserved specifically for TRIO students such as program sponsored tutoring, workshops, and cultural events.

      I also understand that in order to receive the above services, I must meet the citizenship criteria and one or more of the other eligibility requirements as shown below:

    • Clear
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    • By accepting the student into the project, SSS agrees to provide the following:

      1. Educational support services for student (identified through needs assessment).
      2. Assistance in receiving and maintaining financial aid.
      3. Assistance with career exploration and planning.
      4. Referrals to other agencies as needed.
      5. Assistance/support through SSS sponsored educational, cultural, social, and family activities.
      6. College transfer assistance as needed.
    • Clear
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    • To Qualify for Services, all participants must have a documented academic need.

    • TRIO Student Needs Assessment 
    • Educational Assessment (Part 1)


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    • Educational Assessment (Part 2)

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    • Answer the following questions:

    • Transer Assessment


    • Personal Assessment

    • Personal

    • Social and Cultural

    • Transportation

    • Child Care

    • Referrals


    • Other

    • Financial Assessment

    • Employment

    • Financial Aid



    • Other

    • Student Disabilities

    • All Participants must have a documented academic need.

    • Signature 
    • Clear
    • Clear
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    • Submit 
    • Should be Empty: