Western Oregon University-SSS 1-Application Form

TRIO SSS Application
Thank you for your interest in the Student Enrichment Program (TRIO SSS) at Western Oregon University!

TRIO is funded by the U.S. Department of Education to serve students who meet the federal guidelines for low income, first generation college student, and / or documented disabilities. The answers to these questions will be used to determine your types of eligibility for TRIO services and will remain confidential.

Please complete all parts of this application to the best of your ability.

If you need assistance with this application or if you have questions about admission into our program, please contact the TRIO Student Enrichment Program office at 503-838-8550 or sep@wou.edu or visit the SEP Office in the Advising Center.

If you are an education major and plan to go into teaching, the TRIO Teacher Prep Student Support Services Program may be a better fit for you. You may not be in both SEP and TPSSS. If you would like to continue with your SEP application, please finish this form. If you'd like to apply for TPSSS instead, please go to wou.edu/tpsss.

Before you begin: At the end of this application, we ask for responses to two questions. Please have your answers ready, so you can copy & paste them into this application. We ask these questions to evaluate your fit for our program and your commitment to utilizing our services.

1) Tell us about your greatest academic challenges. How do they most impact your
educational experience?
2) Tell us about your greatest personal challenges. How do these challenges most impact your educational experience?
Personal Information
All of your answers to these questions will remain confidential and will be used
only to determine your eligibility for our program.
Legal Name*

First NameLast Name
Preferred Name

First NameLast Name
WOU Student ID (V Number)
If you don't know your V#, that's okay!
Best Phone Number: Ideally your (the student's) primary cell phone number*
(999)999-9999
WOU Email Address*
example@example.com
Best Way to Contact?*

Email (Your WOU email.)PhoneText Message
Date of Birth*

MonthDayYear
mm-dd-yyyy
Our program is funded by the U.S Department of Education that only allows us to provide you with these two options. This is only for reporting purposes.
Gender*

FemaleMale
Which most closely describes your gender?

FemaleMaleNonbinaryTransgender femaleTransgender maleGender not listedPrefer not to state
Have you been a Foster Student? Since the age of 13, have you ever been in the foster system, even if you are no longer in foster care?*

YesNo
Race: Check all that apply*

American Indian/AlaskanAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or Other Pacific IslanderWhite
What is your Residency Status? This answer is only used to determine eligibility. It is not shared with any other entities and is kept confidential.*

US CitizenPermanent ResidentNeither
Current Education Information
WOU Major*
This may be your current major, what you intend to major in, or you can put "Undecided/Exploratory" if you aren't sure yet. If you are an Education major, you may be better served in the TRIO Teacher Prep Student Support Services Program instead of the Student Enrichment Program.
What term and year did you start or will you start your attendance at WOU?*
Example: Fall 2022
College Grade Level at time of Application*

Freshman / 1st Year (0-44 credits)Sophomore (45- 90 credits)Junior (91 - 134 credits)Senior (135+ credits)
Are you a transfer student?*

YesNo
Please list your last High School attended and your last College attended (if any):*
Did you earn a High School Diploma or a GED?*

High School diplomaGEDOther
Has it been five or more years since you last attended school?*

YesNo
Financial Eligibility:

TRIO Student Support Services is funded to serve students who meet the federal guidelines for low income eligibility. Your income eligibility will be determined from information obtained from the WOU Financial Aid office from information you provided on your FAFSA or ORSAA. If we need any additional information, we will reach out to you individually.

All information obtained in this application will remain confidential.

First Generation Eligibility:

TRIO Student Support Services is funded to serve students who meet the federal
guidelines for being the first generation of a family to attend college. This
means your parents or legal guardians do not have a bachelor's degree, but
other siblings or family members may have attended college or obtained a
degree.
Does the parent or legal guardian who raised you have a 4-Year Bachelor's Degree?*

YesNo
Have you currently earned a Bachelor's degree?*

YesNo
Disability Eligibility:

TRIO Student Support Services is funded to serve students who meet the federal guidelines for having a documented disability.
Do you feel you may be eligible for accommodations from WOU for a disability? A NO answer does not necessarily disqualify you for TRIO services. We will not request information about your specific disability.*

YesNo
Office of Disability Services

If you feel you may be eligible for accommodations, please reach out to the Office of Disability Services at 503- 838-8250, ods@wou.edu, or in person at the office in APSC 405.

Academic Information

The following information is used to tailor the services we offer to SSS participants.
Have you previously received services from a TRIO program or other academic support program?*

NoneAvidAspireUpward BoundTalent SearchSSS - Student Support ServicesOther
Where did you receive each of these services?
Please list the high school or college and corresponding program.
What is your career goal?*
If you aren't sure, please write "Undecided/Exploratory".
Short Answer Questions

These questions help SSS to evaluate your fit for these programs and your
commitment to utilizing the TRIO services. Spelling and grammar are not scored,
but it should be clear that you used spell-check.
What SEP services are you most interested in receiving? Check all that apply*

Educational AdvisingPersonal AdvisingCourse Selection AssistanceFinancial Aid AssistanceGrad school application assistanceHow to manage my money (Financial Literacy)Career counselingClass & study resourcesTextbook / Chromebook / Graphing CalculatorReferrals to other WOU servicesTutoring
What interests you most about the services you chose? How would these services be particularly helpful to you? (Please give a minimum of 4 sentences in explanation.) *
Please explain in one short paragraph.
How confident are you in your college math skills? Your answers to this question will not impact your eligibility for our program.*

1 (Not confident at all)2345 (Very confident)
How confident are you in your college reading skills? Your answers to this question will not impact your eligibility for our program.*

1 (Not confident at all)2345 (Very confident)
How confident are you in your college writing skills? Your answers to this question will not impact your eligibility for our program.*

1 (Not confident at all)2345 (Very confident)
Tell us about your greatest academic challenges. How do they most impact your educational experience? (Please give a minimum of 4 sentences in explanation.) *
Please elaborate in one short paragraph.
Tell us about your greatest personal challenges. How do these challenges most impact your educational experience? (Please give a minimum of 4 sentences in explanation.) *
Please elaborate in one short paragraph.
Participation in the Student Enrichment Program requires meeting with your assigned SEP advisor at least twice per term. Are you willing to make this commitment?*

YesNo
Release of Confidential Information
I hereby give my permission for the release of the following confidential information to the Western Oregon University Student Enrichment Program:

Midterm and Final Grades, Financial Aid Records, Standardized Test Scores/Assessments, Disability Documentation (if applicable), Educational Records/Transcripts/Registration Information, Contact with Professors, Counselors, Tutors, Vocational Rehabilitation, Veterans Affairs. I understand that all information released and discussed will be utilized only for the benefit of my educational program at WOU.
I hereby apply for admission to the Western Oregon University TRIO Student
Support Services program. If I am admitted to TRIO SSS, I understand that I will
be reported as a TRIO SSS student for up to six (6) years until I graduate and/or
leave the university. The information I have provided is accurate and true, to the
best of my knowledge. By typing my full name below I am signing this application.
Name*

First NameLast Name
Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy

TRIO SSS Application