University Of Louisville-SSS-2022 Application Form

University of Louisville TRIO Student Support Services APPLICATION
Davidson Hall, Room 106 Louisville, KY 40292

Phone: 502-852-1406

Fax: 502-852-6591
Date

MonthDayYear
mm-dd-yyyy
- Social Security #:*
  999-99-9999
- Student ID #:*
- Full Name:*
  
  First NameMiddle NameLast Name
- Preferred Name (If different from above):
  
  First NameLast Name
- Local Mailing Address:*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Permanent Mailing Address (If different from above):
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Cell Phone Number:*
  (999)999-9999
- Alternate Phone Number:
  (999)999-9999
- UofL Email Address:*
  john.doe@louisville.edu
- Date of Birth*
  
  MonthDayYear
  mm-dd-yyyy
- Emergency Contact:*
  
  First NameLast Name
- Relation:*
- Phone Number:*
  (999)999-9999
- High School Diploma:*
  
  YesNo
- GED:*
  
  YesNo
- High School GPA:*
- High School Graduation Date:*
- Are you a transfer student?*
  
  YesNo
- If yes, from what institution?
- Education Status:*
  
  1st semester at UofL, FreshmanFreshmanSophomoreJuniorSenior
- Major:*
- Minor:
- TRIO Program you have participated in:*
  
  Upward BoundEducational Talent SearchGear UpMcNairEducational Opportunity CenterStudent Support ServicesNone
- If SSS, where?
- Gender (Sex Assigned at Birth):*
  
  MaleFemale
- Pronouns (Optional):
  
  She/her/hersHe/him/hisThey/Them/TheirsOther
- Race:*
  
  American Indian/Alaskan NativeAsianBlack/African AmericanWhiteNative Hawaiian/Pacific IslanderHispanic or LatinoMore than one race
- Are you a veteran of the U.S. Armed Forces?*
  
  YesNo
- Are you an active member in the U.S. Armed Forces?*
  
  YesNo
- U.S. Citizen:*
  
  YesNo
- Permanent Resident:*
  
  YesNo
- Are you a first-generation college student (You are a first-generation college student if your parent/guardian DID NOT receive a 4-year, Bachelor’s Degree)?*
  
  YesNo
- Do you have a documented/verifiable disability (physical, learning, emotional)?*
  
  YesNo
- If yes, are you registered with UofL Disability Resource Center (DRC)?*
  
  YesNoN/A
- If you are not registered with DRC, are you able to provide documentation of disability to the SSS office?*
  
  YesNoN/A
- Family Status:*
  
  SingleMarriedHead of Household/SingleDependent on parent’s income
- Including yourself, how many people live in your household?*
- Are you receiving financial aid for the current academic year at the University of Louisville?*
  
  YesNo
- To verify income information, FAFSA documents and information on file with Financial Aid will be reviewed as it relates to the Department of Health and Human Services Poverty Guidelines for TRIO to determine income requirements. You may be contacted and asked to provide additional financial information.
- 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):*
  
  General Career GuidanceInterview TechniquesObtaining internshipsPreparing a ResumeSummer Research ProgramsConfidence, Social SkillsLeadership DevelopmentTime Management SkillsPersonal GoalsSelecting CoursesStudy/Note-Taking/Test-TakingTutoringScholarly ResearchIncrease GPACritical Thinking SkillsEducational GoalsMoney ManagementFinancial Aid InformationFinancial Assistance (grants)Help with FAFSAScholarship Search AssistanceApplying to Graduate SchoolGraduate School VisitsPrepping for Graduate Exams
- What workshops/seminars are you interested in attending? (Check all that apply):*
  
  Stress ManagementStudy SkillsPeer/Social RelationshipsGraduate SchoolBudgeting for CollegeCultural EnhancementTime ManagementInternational Learning OpportunitiesFinancial AidOther
- 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
  
  Clear
- Date
  
  MonthDayYear
  mm-dd-yyyy
- Student Signature
  
  Clear
- Date
  
  MonthDayYear
  mm-dd-yyyy

University of Louisville TRIO Student Support Services APPLICATION