Western Kentucky University-SSS-Application Form

WKU TRIO Student Support Services
Thank you for your interest in joining the Student Support Services project at WKU. Our project is one of many federally grant funded projects designed to provide additional accountability and support for student populations often underrepresented in higher education.

Qualifying participation in TRIO SSS is competitive. Interested students must:

- Be admitted to WKU as an undergraduate, degree-seeking student.

- Be a United States citizen or legal permanent resident.

- Demonstrate need for academic support, as determined by the WKU TRIO SSS project, in order to successfully pursue a postsecondary educational project.

Additionally, students meeting the following criteria will be given priority in acceptance. Priority applicants may:

- Be a first-generation college student. (see definition on question #11)

- Come from a low-income background based on taxable income and household size (see income table on questions #12 and #13)

- Have a documented disability/diagnosis on file with WKU’s Student Accessibility Resource Center (SARC). (see definition on question #14)

If you have any questions, comments, or concerns, feel free to contact our office by emailing studentsupportservices@wku.edu or by calling (270) 745-4308.
Personal Information
1. What is your WKU ID# (800… Or 801…)?*
2. What is your legal name? If you do not have a middle name, please put N/A*

First NameMiddle NameLast Name
3. What is your preferred/chosen name, if applicable?*
4. What are your pronouns?*
5. What is your gender?*
6. What is your legal sex?

MaleFemalePrefer not to say
7. What is your birthday?*

MonthDayYear
mm-dd-yyyy
8. Do you identify as Hispanic/Latinx?*

YesNo
9. What is your race? You may select more than one.*

American Indian/Alaskan NativeAsianBlack/African AmericanNative Hawaiian/Pacific IslanderWhite
Eligibility Information
10. Are you a United States citizen or legal permanent resident? (classified as a permanent resident alien or refugee in the process of seeking citizenship)?*

YesNo
First-Generation College Student Status

A first-generation college student is defined as (1) A student neither of whose natural or adoptive parents received a baccalaureate degree; (2) A student who, prior to the age of 18, regularly resided with and received support from only one parent and whose supporting parent did not receive a baccalaureate degree; or (3) An individual who, prior to the age of 18, did not regularly reside with or receive support from a natural or an adoptive parent.
11. Based on this definition, are you a first-generation student?*

YesNo
Income Verification

Documentation of household size and taxable income is required to determine financial eligibility for participation in the TRIO SSS program. Please use your most recent tax return data to complete the income verification information below.

Application cannot be processed without taxable income information; it may be zero.
12. What is your family size as reported on your FAFSA?*
13. What was your family’s taxable income on your most recent tax return? Use box 15 from the 1040 form. If you don’t know, make your best guess. We will follow up with you and/or the WKU Office of Student Financial Assistance to verify.*
Disability Attestation

The term disability means, with respect to an individual— (A) a physical or mental impairment that substantially limits one or more major life activities of such individual; (B) a record of such an impairment; or (C) being regarded as having such an impairment.
14. Do you have a documented disability/diagnosis on file with the WKU Student Accessibility Resource Center (SARC)?*

YesNo
Contact Information
15. What is your WKU email address?*
example@example.com
16. What is your cell phone number?*
(999)999-9999
17. What is your preferred contact method? You may select more than one*

WKU emailPhone callText message
18. What is your permanent/mailing address? *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
19. Is your local/on-campus address the same as your permanent mailing address?*

YesNo
20. What is your local/on-campus address? (or residence hall and room number, if applicable)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Demonstration of Academic Need
21. Which of the following apply to you? You may select more than one.

Low college grades (less than 2.0 cumulative GPA)Out of academic pipeline for 5+ yearsLimited English proficiency (ESL classes in high school or recent immigration)Lack of educational/career goals (undeclared major)Lack of college academic preparedness (no dual credit or AP classes)Need for support to raise grades (Cornerstone program)Low high school grades (less than 2.5 cumulative GPA)Low admission test scores (less than 20 on ACT, less than 1050 on SAT)High school equivalency (GED)Transfer student (2 or more schools)Lack of support networkApplicant is a single parentWorking 20+ hours/weekCommuting 40+ miles/dayHealth issues (physical, emotional, mental, sexual identity, etc.)None of these
21. What high school did you attend?*

Name

Street Address Line 2

CityState / Province

Postal / Zip Code
22. What year did you graduate?*
23. What was your GPA at time of graduation?*
Current Academic Information
24. What is your anticipated/declared major?*
25. When is/was your first semester at WKU?*
(e.g. Spring 2021 or Fall 2023)
26. Are you a transfer student?*

YesNo
22. Will you be enrolled this upcoming fall semester at WKU?

YesNo
23. Have you participated in another TRIO program before (ETS, Upward Bound, SSS)?*

Educational Talent SearchUpward BoundStudent Support Services at another institutionEducational Opportunity Center (EOC)I’m not sureNo
24. How did you hear about the Student Support Services office?*

FriendFaculty/StaffFamily memberNew student orientation (TOP)M.A.S.T.E.R. PlanFrom another TRIO program in which you were a participantOther
Services Information
25. Below is a list of services available through the Student Support Services project. Please check any of the services that you would find beneficial to your academic success.*

Assistance with course selectionAcademic skills coaching (time management, study skills, test-taking strategies, etc.)Academic tutoring (peer and/or group)Connecting with the campus and surrounding communityCareer coaching and explorationCultural and academic exposureFAFSA and financial aid help (loans, scholarships, FAFSA assistance)Financial literacy education (budgeting and money management)Graduate school preparationSocial and emotional support
26. Is there anything else you think we should know? Questions, comments, concerns, etc.*
Agreements and Signature
27.
1. I give permission for Student Support Servies project personnel to access my WKU academic records for the purpose of verifying my project eligibility and assisting me academically.
2. I consent for the SSS staff to contact the student financial assistance office to share taxable income and household size (federal tax information) for the purposes of determining eligibility and potential grant aid.
3. I understand that acceptance into the project is for this current school year only and I am not guaranteed continuance in the project after this school year.
4. I agree to actively participate in the Student Support Services project including the project orientation, various academic assessments, and pre-registration advisement. Continued involvement is dependent upon my active participation.
5. If I marked myself as having a disability, I agree to provide WKU’s SARC office with current documentation of my disability for the purpose of verifying eligibility, supporting accommodations, and determining academic potential.
6. I authorize my participation (interviews, photos, etc.) in program marketing efforts.
7. I declare the above information is true and correct to the best of my knowledge.
I understand that checking “I Accept” and typing my full name in the box below constitutes an electronic signature.*

I acceptI decline
28. Please type your full name in the box below.*

First NameLast Name
Thank you for applying to the Student Support Services project at WKU! Our staff will begin reviewing your application. Once their review is complete, you will be contacted by email with more information regarding your approval into the project, any additional documentation we may need, etc.

If you have any questions, feel free to email us at studentsupportservices@wku.edu or give us a call at (270) 745-4308.

Go Tops!

WKU TRIO Student Support Services

Personal Information