Western Oregon University-SSS 2-Application Form

  • TRIO Teacher Prep SSS Application

  • Thank you for your interest in the TRIO Teacher Prep Student Support Services (TPSSS) program for Education majors 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: federal guidelines for low-income, first-generation college students, and / or eligible to receive services through WOU Disability Access Services (DAS). The answers to these questions will be used to determine your eligibility for TRIO services and will be kept confidential.


    Please note, you will be asked to provide your family's taxable income (depending on if you are dependent or independent according to your FAFSA), therefore, we recommend you gather income tax information before you begin this application.


    If you need assistance with this application or if you have questions about admission into our program, please contact the Teacher Prep SSS office at tpsss@mail.wou.edu or visit the TPSSS Resource Center in SSC 124.

    • Personal Information 
    • Best way to contact you: (check all that apply)*
    • Date of Birth*
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    • Gender*
    • What is your residency status? This answer will be used to determine eligibility and your response will not exclude you from participation.*
    • What is your residency status? (This answer will be used to determine eligibility and your response will not exclude you from participation.)*
    • Ethnicity: Do you identify as Hispanic or Latino?*
    • Race: Please select the racial categories with which you identify. This information is necessary, even if you selected an ethnic identity of Hispanic or Latino above, based on reporting requirements per the Department of Education.*
    • Since the age of 13, are you or have you been in the foster care system?*
    • Have you been accepted into WOU under one of these programs?*
    • Current Education Information 
    • Have you earned a HS diploma or GED?*
    • Have you previously earned a Bachelor’s degree?*
    • Current college grade level at time of application:*
    • Are you a transfer student?*
    • Have you been awarded one of the following?*
    • Has it been five or more years since you last attended any school?*
    • Financial Eligibility Information 

    • 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.

    • I understand how my low income eligibility will be determined.*
    • Have you been eligible for a Pell Grant in previous years?*

    • If you mark "yes" for this question AND "no" for the following question, you may be contacted for additional verification of your most recent taxable income which may be different from what was reported on your FAFSA or ORSAA. This information will be kept confidential.

    • Are you eligible for a Pell Grant this year?*
    • 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, the number of people in your household, and sign below.

      Independent Student:

      If you are an independent student, please list only your household annual taxable income, the number of people in your household, and sign below.

    • Income_chart
    • 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?*
    • 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 eligible 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?*
    • Academic Information 

    • The following information is used to tailor the services we offer to a TPSSS participant.

    • Have you previously received services from other TRIO Student Support Service programs or other academic support programs? Check all that apply*
    • Short Answer Questions 

    • To help us understand a little more about who you are and why you are interested in our program, please select the service(s) that you feel will benefit you the most. (Please check all that apply.)*

    • To help us understand a little more about who you are and why you are interested in our program, please select the services you feel will benefit you the most. (Please check all that apply.)*
    • How confident are you in your college math skills?*
    • How confident are you in your college reading skills?*
    • How confident are you in your college writing skills?*
    • Participation in the TPSSS program requires meeting with your assigned advisor at least twice per term. Are you willing to make this commitment?*
    • Signature 

    • My signature below indicates that I hereby give my permission for the release of
      the following information to the Western Oregon University TRIO Teacher Prep SSS
      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 and other WOU service providers


      I understand that all information released to TPSSS 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 Teacher Prep Support Services program. If I am admitted to TRIO TPSSS, 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. The information I provided is accurate and true, to the best of my knowledge. 

    • Clear
    • Date
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    • Submit 
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