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 at least one of the following requirements: 

    1. Federal guidelines for low-income,
    2. First-generation college student,
    3. And /or Eligible to receive services through the WOU Disability Access Services department (DAS). 

    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, go to our webpage at wou.edu/sep or visit the TRIO SEP Department on the first floor in the Student Success Center (SSC #109). Please feel free to email sep@wou.edu with any questions you may have.

    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.

    • Personal Information 

    • All of your answers to these questions will remain confidential and will be used
      only to determine your eligibility for our program.

    • Best Way to Contact?*
    • Date of Birth*
       - -
    • Gender*
    • Which most closely describes your gender?
    • Ethnicity: Do you identify as Hispanic or Latino?*
    • Race: (Check all that apply.) Please select the racial categories with which you identify. This information is necessary, based on reporting requirements per the Department of Education. *
    • 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?*
    • 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.*
    • Have you been awarded a Diversity Commitment Scholarship?*
    • Current Education Information 
    • Did you earn a High School Diploma or a GED?*
    • College Grade Level at time of Application*
    • Are you a transfer student?*
    • Have you previously earned a Bachelor's degree?*
    • Has it been five or more years since you last attended school?*
    • Have you been awarded a Diversity Commitment Scholarship?
    • First Generation Eligibility: 

    • TRIO Student Support Services are funded to serve students whose parents or legal guardians do not have a four-year college degree. This information is only to help determine your eligibility for services. Not being First Generation does not exclude you from participation.

    • Has your parent or legal guardian earned a degree from a four-year university?*
    • Have you currently earned a Bachelor's degree?*
    • Financial Eligibility: 

    • TRIO Student Support Services are funded to serve students who meet federal low-income guidelines. Not meeting the low-income threshold does not exclude you from participation.

      This information is only to help determine your eligibility for services. It will not be used for any other purpose and will be kept confidential.


      All information obtained in this application will remain confidential.

    • You are considered an independent student if one of the following is true (please specify):
    • Are you an independent student:

    • Dependent Student:

      You are considered a dependent student if none of the above applied to you, even if you don’t live with your parents, they don’t support you financially, or claim you on their taxes.

      As a dependent student, your parents/legal guardians must verify the annual household taxable income (AGI), the number of dependents claimed on taxes, and sign below.

      Independent Student:

      If you are an independent student, please list only your household annual taxable income(AGI), the number of dependents claimed on taxes, and sign below.

    • Low-Income Levels
    • Disability Eligibility 

    • TRIO Student Support Services are funded to serve students who are eligible to receive accommodations through WOU Disability Access Services. This information is only to help determine your eligibility for services. Not being eligble for accommodations does not disqualify you for services. We will not request information about your specific disability.

    • Do you feel you may be eligible for accommodations from WOU Disability Access Services?*

    • Income Verification

      Dependent Student:

      You are considered a dependent student if none of the above applied to you, even if you don’t live with your parents, they don’t support you financially, or claim you on their taxes.

      As a dependent student, your parents/legal guardians must verify the annual household taxable income (AGI), the number of dependents claimed on taxes, and sign below.

      Independent Student:

      If you are an independent student, please list only your household annual taxable income(AGI), the number of dependents claimed on taxes, and sign below. 

    • 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.*

    • Disability Eligibility:

      TRIO Student Support Services is funded to serve students who meet the federal guidelines for having a documented disability.

    • Office of Disability Services

      If you feel you may be eligible for accommodations, please reach out to the Disability Access Services at 503- 838-8250, or email das@wou.edu, or visit them in person at the office in the Student Success Center (SSC) on the first floor #105.You can apply for services: Apply – Disability Access Services

    • Income Verification

      Dependent Student:

      You are considered a dependent student if none of the above applied to you, even if you don’t live with your parents, they don’t support you financially, or claim you on their taxes.

      As a dependent student, your parents/legal guardians must verify the annual household taxable income (AGI), the number of dependents claimed on taxes, and sign below.

    • Clear

    • Independent Student:

      If you are an independent student, please list only your household annual taxable income(AGI), the number of dependents claimed on taxes, and sign below. 

    • Clear
    • 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?*
    • What SEP services are you most interested in receiving? Check all that apply*

    • 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.

    • How confident are you in your college math skills? Your answers to this question will not impact your eligibility for our program.*
    • How confident are you in your college reading skills? Your answers to this question will not impact your eligibility for our program.*
    • How confident are you in your college writing skills? Your answers to this question will not impact your eligibility for our program.*
    • 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?*
    • Signature 

    • Release of Confidential Information
      My signature below indicates that I hereby give my permission for the release of the following information to the Western Oregon University TRIO 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.

    • My signature below indicates that I hereby give my permission for the release of
      the following information to the Western Oregon University TRIO SSS Student Enrichment Program:


         Midterm / Final Grades
         Financial and Tax Records
         Standardized Test Scores / Assessments
         Confirmation of eligibility for disability accommodations
         Educational Records / Transcripts / Registration information
         Contacts with Professors, Veterans Affairs and other WOU service providers


      I understand that all information released to the TRIO Student Enrichment Program and discussed with me will be
      utilized only for the benefit of my educational program at WOU.

      I hereby apply for admission to the WOU TRIO TRIO SSS Student Enrichment Program. If I am admitted to TRIO SEP, I understand that my participation will be reported to the U.S. Department of Education as a TRIO SSS student for up to six (6) years until I graduate and/or leave the university. The information I provided is accurate and true, to the best of my knowledge. 

    • Clear
    • Clear
    • Date
       - -
    • Date*
       - -

    • All fields marked with * are required and must be filled in.

    • Submit 
    • Should be Empty: