Georgia State University-Newton-SSS-Application Form

TRiO Student Support Services
PATHWAYS TO SUCCESS PROJECT
Georgia State University Perimeter College, Newton
Application for Participation

Please submit your SSS application by as soon as possible for the best chance of securing a place in this highly competitive program! Applications are accepted past this date until the program is full. Updates regarding the status of a student’s application are sent to the GSU e-mail account. PLEASE make sure your application is complete upon submission to avoid a delay in consideration. If you have any questions about the TRiO SSS program and/or the application process, feel free to contact the SSS office at sssnewton@gsu.edu.

Communication Information
Do you agree to accept and receive SSS program text messages?*

YesNo
What is your preferred method of communication?*

Text messageGSU Perimeter College EmailPhone

Military Connection Information
Veteran Status
Are you a member of the U.S. Armed Forces? *

YesNo
If yes, dates of active duty
Are you a member of the U.S. Reserve Forces*

YesNo
If yes, dates
Are you a child or spouse of a military-connected person? If so, please check the appropriate box below

ChildSpouse

Educational Information
Did you earn a high school diploma? *

YesNo
Did you earn a GED?

YesNo
Have you completed a bachelor’s degree?

YesNo
Name of your high school
What is your academic classification for the upcoming school year?*

FreshmanSophomore
Are you*

A current Perimeter College-Newton studentA transfer student from another college/universityA student working with the Access & Accommodations departmentA current College Assistance Migrant Program (CAMP) studentA former CAMP student
Are you (Check all that apply)*

A current Perimeter College-Newton studentA transfer student from another college/universityA student working with the Access & Accommodations departmentA current College Assistance Migrant Program (CAMP) studentA former CAMP student
Were you a TRiO participant at another school? *

YesNo
If so, check all that apply

Upward BoundUpward Bound Math/ScienceTalent SearchSSSSSS Math/Science
Please specify which high school, college, university, or agency that hosted the TRiO programs in which you participated

When did/will you start at Georgia State University’s Perimeter College, Newton?*

	Starting Date Information
Semester
Year

What is your intended major?*
Attendance at Perimeter College-Newton? *

Full-timePart-time
What is your expected graduation from Perimeter College-Newton? *
Month/Year
What are your career goals? What type of job are you hoping for?*
Do you intend to earn a bachelor’s degree? *

YesNo
If so, which university?

Georgia State UniversityOther
Do you intend to graduate from Georgia State University’s Perimeter College-Newton? *

YesNo

Release of Information
- I give my SSS Director and Education Program Specialists permission to communicate with professors/advisors/tutors and other GSU Perimeter College-Newton professionals to discuss academic information.
- I give permission to release my name for recognition purposes (scholarships, awards, etc.).
- I understand that completion of this application does not constitute acceptance into the TRIO Student Support Services program. I also understand that if I am accepted, I will be assigned to a TRIO SSS Education Program Specialist, will be encouraged to take advantage of tutoring, academic advising, and workshops; participate in educational and cultural opportunities. Program participation is necessary to remain in the program.
- I hereby give permission for TRIO SSS staff to disclose and receive information concerning the nature of my eligibility and information concerning my academic progress on an as-needed basis with appropriate faculty and staff at Georgia State University Perimeter College, Newton. I also give TRIO SSS staff permission to photograph me for promotional purposes, to view and receive any/all financial aid information, as well as receive information from past, current, and future schools. By initialing and submitting this application I am signifying that I have read and understood this application, and that what I have reported is truthful and accurate.
Digital Signature

Clear
Date

MonthDayYear
mm-dd-yyyy
Status

AcceptWait listRejected