Eastern Oklahoma State College-SSS

  • Program Application

    Eastern Oklahoma State College • www.eosc.edu/trio
    1301 West Main • Wilburton, OK 74578 • 918.465.1825
    Johnston Hall 112 in Wilburton • Information Center in McAlester

  • The following information is requested to determine your eligibility for program services. Please answer each question. This information will be kept confidential and used only as outlined in the participant agreement.

    • Personal Information 
    • May We Text You? (study tips, reminders, events, etc.)
    • Date of Birth*
       - -
    • Gender (optional)
    • Race/Ethnicity and Residency Information 
    • Which group best describes you? Please select all that apply.
    • U.S. Citizen
    • Legal Permanent Resident?
    • Are you Hispanic?
    • Additional Information 
    • Are you receiving federal financial aid?
    • Did either of your parents receive their bachelor's (four-year) degree?
    • Do you have a documented learning disability?
    • Do you have a documented physical disability?
    • If you answered yes to either question above, are you working with the EOSC disabilities counselor?
    • Are you a veteran?
    • Are you receiving veteran's benefits?
    • Are you a single parent?
    • Are you a prior TRiO participant?
    • Educational History 
    • What is your current grade level?
    • Current college enrollment status
    • What degree are you seeking at EOSC?
    • Do you plan to transfer to a four-year college or university?
    • Student Services Support Needs and Services 
    • How can the TRiO Student Support Services Program best support your educational goals? Please select all that apply.

    • Workshops
    • What obstacles may affect your ability to achieve your academic goals? (Check all that apply)

    • Signature 
      • I understand that if I am receiving financial aid, TRiO SSS staff will obtain my financial information. If I am not receiving financial aid, I will provide a copy of my most recent tax return.

      • I understand that I will have access to the TRiO SSS program at no additional cost beyond my regular tuition and fees as an EOSC student.

      • I understand that the TRiO SSS staff may confer with my instructors at any time concerning my progress and grades.

      • I understand that the TRiO SSS staff are not licensed counselors and students with ongoing personal issues will be referred to professional counselors.

      • I understand that I must participate in the TRiO SSS activities that my SSS advisor assigns to me based upon my needs assessment and by full filling this requirement, I will be eligible to apply for the SSS grant aid scholarship.

      Affidavit of Truth Statement

      The information provided on this form is, to the best of my knowledge, accurate and true.

    • Clear
    • Date
       - -
    • Submit 
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