Rogers State University TRIO Student Support Services Application

1701 W Will Rogers Blvd, Claremore, OK 74017

Prep Hall 105

918-343-7575

 

Rogers State University (RSU) TRIO Student Support Services (SSS), you must be currently enrolled in at least 6 hours of 1000 level courses or above at RSU (or for the Semester Following your application), and you must meet at least one of the following criteria:

• First generation college student (neither parent has a four-year college degree).
• Financially disadvantaged (Determined by federal guidelines/FAFSA on file with RSU Office of Financial Aid).
• Have a documented physical or learning disability.

The following Eligibility information is required and kept strictly confidential.

SSS is a federally funded grant from the U.S. Department of Education. SSS must document students’ eligibility (Potential First-Generation Student). All information requested below is for this purpose and will be kept strictly confidential.

The following Income information is required and kept strictly confidential.

SSS is a federally funded grant program and is required by the U.S. Department of Education to obtain income information for participants (and their parents/guardians if the student is considered DEPENDENT on the FAFSA).

A copy of the previous year’s tax return may be requested by the SSS program if further information is needed.

Please complete the information below. Verification requirements for SSS vary depending on whether students are independent or dependent based on their completed FAFSA. Please check 1 or 2 to best determine your eligibility status.

The information you have provided will be used for the sole purpose of determining and verifying your eligibility for SSS. All information is kept strictly confidential and is never passed on to any other agency. The U.S. Department of Education provides more information about SSS and eligibility requirements online: http://www.ed.gov/about/offices/list/ope/trio/index.html RSU TRIO SSS is 100% federally funded at a cost of $261,888 and does not discriminate on the basis of age, race, color, religion, sex, sexual orientation, genetic information, gender identity or expression, national origin, disability, protected veteran status, or other protected category, in any of its policies or procedures. This provision includes but is not limited to admissions, employment, financial aid, and educational services.

My signature below certifies that the information provided on this form is correct and complete to the best of my knowledge.

If you are selected and choose to participate in the Student Support Services program at RSU you are committing to the following:

WE REQUIRE THE FOLLOWING COMMITMENT FROM YOU:

• I WILL participate in tutoring/mentoring sessions as required.
• I WILL keep advisement appointments as required.
• I WILL attend at least one cultural event each semester.
• I WILL maintain at least a cumulative GPA of 2.0.
• I WILL attend at least two (2) approved TRIO Talks or enrichment seminars each semester.
• I WILL follow the RSU’s Student Code of Conduct and agree to abide by its policies
• I WILL meet with an SSS Advisor at least 1-2 times per semester.

RSU SSS Staff reserve the exclusive authority to accept or remove applicants/ participants from the SSS program at any time based on professional discretion concerning mutual program benefit.

I acknowledge and understand the above and agree to this commitment. Not upholding my responsibilities will result in termination/removal from the SSS program and all of the provided services.

My signature on this form gives permission for appropriate staff members of Student Support Services to verify and/or access necessary information from RSU Student Development, Enrollment Management, and Financial Aid Services to determine my eligibility for the SSS program as required under program grant guidelines and federal regulations.

Permission is hereby granted for appropriate staff to consult with faculty/staff on campus at any time during my academic career to help me succeed in my academic pursuits and to graduate from Rogers State University including grades, attendance, etc.

I understand the SSS staff members will have access to academic information and may use that information in assisting their goal of improving retention and academic performance.

By signing, I agree to hold harmless Rogers State University and Student Support Services of any liability. I hereby waive any right to inspect or approve the finished photographs or printed material that may be used in conjunction with them now or in the future.