University Of Louisville-SSS-2022 Application Form

In your own words, what do you hope to gain from participating in TRIO Student Support Services?*

What is your need for support in our program? (Check all that apply):*

What workshops/seminars are you interested in attending? (Check all that apply):*

The University of Louisville TRIO SSS may send SMS text messages to provide information and services related to the TRIO Student Support Services program. Text messaging rates and fees from mobile carrier may apply. Please, check the box if you wish to OPT-OUT of receiving text messages from TRIO SSS.

I opt-out of receiving text messages from TRIO SSS regarding program services.

By signing below, I certify that all the information which I have provided is true and correct to the best of my knowledge. I understand that Student Support Services (SSS) staff will use the data provided on this application to assist in determining my eligibility for the program. I also consent to give SSS staff permission to request the University of Louisville Financial Aid Office to review and report back my FAFSA information as it relates to the Department of Health and Human Services Poverty Guidelines in order for TRIO to determine eligibility for the program, provide program services, and obtain potential grant aid. My signature signifies that I have read and understand this statement and that I am signing free of force or duress.

Parent or guardian signature if under 18 years of age

Date

mm-dd-yyyy

Student Signature

Date

mm-dd-yyyy

University of Louisville TRIO Student Support Services APPLICATION