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 participant in TRIO SSS.
ELIGIBILITY INFORMATION

Students may establish eligibility based on taxable income, status as a first-generation college student, or a documented disability. All information will be verified by Office of Financial Aid and/or Accessibility Resource Center (ARC).
Are you a first-generation college student? (Your parent(s)/legal guardian(s) DID NOT COMPLETE A BACHELOR’S DEGREE before you turned 18.)*

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-$22,590$22,591-$30,660$30,661-$38,730$38,731-46,800$46,801-$54, 870$54,871-$62,940$62,941-$71,010$71,011-$79,080$79,081 and up
I agree that TRIO may contact the Office of Financial Aid to confirm my income eligibility.

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

Math HelpReading SkillsScienceWriting SkillsForeign LanguageSocial ScienceArts & HumanitiesComputer SkillsResearch SkillsOrganization SkillsFinancial LiteracyCareer GoalsFinancial Aid CounselingAccess to resourcesTime ManagementStudy SkillsNote TakingTest Taking SkillsGraduate School GoalsCultural EnrichmentPersonal CounselingAcademic AdvisingGraduation PlanGoal-settingTechnology useFAFSA 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, finding a sense of belonging, joining clubs/organization, family issues, excessive worrying, otherCultural Enrichment: Diversity awareness, handling cultural issues, understanding others, etc
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