University of North Carolina at Pembroke-SSS-Application Form

University of North Carolina at Pembroke

TRIO Student Support Services (SSS)

2025-2026 Student Application
Name*

First NameMiddle InitialLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip
Phone #*
(999)999-9999
Email (Bravemail only)*
example@example.com
Banner*
DOB*

MonthDayYear
mm-dd-yyyy
Gender Identity*
Gender*

MaleFemale
Race/Ethnicity*

American IndianAsianBlack/African AmericanHispanic/LatinoNative Hawaiian/Pacific IslanderWhiteOther
First Date of Enrollment at UNCP*
Are you a transfer student?

YesNo
Current Classification*

Freshman (never attended college)Freshman (attended some college before)Sophomore (30-59 earned credit hours)Junior (60-89 earned credit hours)Senior (90 and up earned credit hours)
If you already have a Bachelor’s Degree, you are not eligible to participate in TRIO SSS.
ELIGIBILITY INFORMATION

A student is eligible for SSS services if the student has U.S. citizenship status and is either low-income, a first-generation college student, or a student with a documented disability. Additional eligibility requirements must also be met. Eligibility is verified with Office of Financial Aid, Accessibility and Resource Center, and/or additional campus departments.
A First-generation college student means: A student neither of whose natural or adoptive parents received a baccalaureate degree; or A student who, prior to the age of 18, regularly resided with and received support from only one parent and whose supporting parent did not receive a baccalaureate degree; or An individual who, prior to the age of 18, did not regularly reside with or receive support from a natural or an adoptive parent.
Are you a first-generation college student?*

YesNo
Have you completed the FAFSA?*

YesNo
Have you received Federal Pell Grant?*

YesNo
Do you have a documented disability?*

YesNo
If yes, are you registered with Accessibility Resource Center (ARC)?

YesNo
Use information based on your federal tax returns or your parents’ federal tax returns (if you are a dependent) to answer the following questions.
What is the total number in your household?*
What is your family taxable income (line 11b of tax form 1040)?*

$0-$23,475$23,476-$31,725$31,726-$39,975$39,976-$48,225$48,226-$56,475$56,476-$64,725$64,726-$72,975$72,976-$81,225$81,226 and up
I agree that TRIO may contact the Office of Financial Aid to confirm my eligibility.

Yes, I agree.No, I do not agree.
STUDENT NEEDS ASSESSMENT
Please identify your academic needs by checking the boxes below.*

Math SkillsReading/Literacy SkillsScience SkillsWriting SkillsComputer SkillsResearch SkillsOrganization SkillsFinancial LiteracyCareer and Workforce DevelopmentFinancial Aid CounselingAccess to resourcesTime Management SkillsStudy SkillsNote TakingTest Taking SkillsGraduate School GoalsAcademic AdvisingDegree Completion PlanGoal-settingTechnology SkillsFAFSA AssistanceAdjusting to collegeOther
Please select one (1) entry below to describe your biggest need for Student Support Services (SSS)*

Low high school gradesPredictive indicator (GPA, SAT, ACT test)Low college gradesFailing gradesLack of educational and/or career goalsNeed for academic support to raise grade(s) in required course(s)/ academic majorLow admission test scoresAcademic Proficient Tests (Diagnostic Tests)High school equivalencyOut of the academic setting for 5 years or moreLimited English proficiencyLack of academic preparedness for college level course work.Other
Please check all services you are most interested in receiving.*

Academic Support: Study skills, time-management, writing, reading comprehension, math, science, note-taking, tutoring, otherAcademic Advising: Understanding degree plan, communicating with advisor, changing major, academic policies, registering for classes, otherFAFSA/Financial Literacy: Completing the FAFSA, understanding award letter, finding loans/grants, understanding student loans, budgeting and saving, investments, checking accounts, otherCareer Planning: Career interests, finding a job, resume writing, interviewing, completing job applications, writing cover letters, professional/employability skills, internships, otherPersonal Development: Stress management, transitioning to college, joining clubs/organization, family issues, excessive worrying, other
Provide any other information to help TRIO SSS determine your needs and how the program can assist you.
How do you think TRIO SSS can help you reach your academic and educational goals?*
Did you participate in a TRIO program before enrolling at UNCP (Upward Bound, Talent Search, Student Support Services)?

YesNo
I agree that the information provided in my application for TRIO SSS is accurate and to the best of my knowledge. If selected as a program participant, I agree to participate in the program.
Student Signature*

Clear
Date Signed*

MonthDayYear
mm-dd-yyyy
Parent Signature (If under 18 years old)

Clear
Date Signed

MonthDayYear
mm-dd-yyyy