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.
Email*
example@example.com

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?*

YesNo

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?*

Yes (Please contact Disability Access Services to discuss accommodations.)NoI don’t know but I would like additional information.

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*

AspireAvidCollege PossibleSSS - Student Support ServicesTalent SearchUpward BoundNoneOther
Where did you receive these services? Please list the high school and/or college with the corresponding program.

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.
By typing my name below, I am signing this application.*

Clear
By typing my name below, I am signing this application.

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