California State University-Northridge-SSS-Application Form

Application for Program Services
What is EOP/TRIO Student Support Services Program?
EOP/TRIO Student Support Services Program is a federally funded program designed to provide academic assistance and enhance educational opportunities for EOP/TRIO SSS Participants. Our program is designed to support the academic needs of 140 eligible California State University Northridge students. Participants are offered a variety of services to ensure a smooth transition to CSUN as well as ongoing support towards the successful completion of their postsecondary education.

This program and its services is offered free of charge to participants.

EOP/TRIO SSS Office location
Bayramian Hall 220 (BH 220)
18111 Nordhoff Street.
Northridge, CA 91330

Phone: 818-677-2358
Email: triosssp@csun.edu
Website: http://csun.edu/csun-eop/eoptrio-student-support-services-program-sssp

Eligibility is based on federally funded criteria:
• Students who meet low-income qualifications
• Students whose parents or guardian have not earned a bachelor’s degree
• Individuals who have a disability

EOP/TRIO SSS Participants must be:
• Admitted and enrolled at California State University Northridge
• Pursuing a first bachelor’s degree
• Demonstrate or self-report academic needs
• Committed to utilizing academic support to earn a bachelor’s degree

EOP/TRIO SSS Application Checklist:
1. SSS Application
2. Two Copies of identification
3. Student Aid Report
How can EOP/TRIO SSS help you?
• Peer mentoring
• Academic, Career, and personal support
• Computer lab and printing access
• Tutoring services
• Graduate school assistance
• Financial literacy education
• Cultural field trips
• Student leadership conference opportunities

Please read and complete all sections on the application. Incomplete applications will delay processing.

FINANCIAL INFORMATION
Please confirm if you are independent or dependent student*

IF YOU ARE AT LEAST 24 YEARS OLD OR IF YOU ARE CONSIDERED TO BE AN "INDEPENDENT” STUDENT ON THE FAFSA, YOU MUST ANSWER THE FOLLOWING QUESTIONS ABOUT YOURSELF.IF YOU ARE 24 YEARS OLD OR YOUNGER AND YOU ARE CONSIDERED TO BE A “DEPENDENT” STUDENT ON THE FAFSA YOUR PARENT / GUARDIAN MUST ANSWER THE FOLLOWING QUESTIONS AND SIGN THIS DOCUMENT TO VERIFY.
Have you completed the FAFSA for this academic year?*

YesNo

Independent
Provide the total number of persons in your household, including yourself*
Select ONE and complete the required information*

Yes, I filed a federal income tax last yearNo, I did NOT file federal income tax last yearNo, I did not have taxable income last year
Provide the STATE you filed taxes in*
Provide your TAXABLE INCOME amount*
Provide your TOTAL INCOME last year*
(If YOU did not file your income tax: submit a statement stating that you did not file income taxes form must be signed)
Upload Income Tax form (must include Taxable Income, usually found in the first two pages) OR Income Tax Statement (Forms must be signed)*

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Additional Documents

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Dependent
Provide the total number of persons in your PARENTS/GUARDIANS household, including yourself*
Select ONE and complete the required information*

Yes, my PARENTS/GUARDIANS filed a federal income tax last yearNo, my PARENTS/GUARDIANS DID NOT file federal income tax last yearNo, my PARENTS/GUARDIANS did not have taxable income last year
Provide the STATE they filed taxes in*
Provide their TAXABLE INCOME amount*
Provide THEIR TOTAL INCOME last year*
(If your PARENTS/GUARDIAN did not file income tax: submit a statement stating that they did not file income taxes form must be signed)
Upload Income Tax form (must include Taxable Income, usually found in the first two pages) OR Income Tax Statement (Forms must be signed)*

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Additional Documents

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INFORMATION & AUDIO/VISUAL RELEASE
Submitting this application enables California State University Northridge (CSUN) EOP /TRIO Student Support Services to obtain necessary academic and personal information and records, including grade reports and transcripts, admission, enrollment, financial aid eligibility and awards, U.S. residency status demographic and contact information, for the purpose of determining eligibility, developing education plans & recording, and collecting program statistics. I authorize the CSUN TRIO Student Support Services to use information and photographs related to my program participation and newsletters, CSUN, EOP/TRIO, WESTOP webpages & social media releases and other program-related publications. This information may be shared with the U.S. Department of Education, California State University Northridge and TRIO personnel in accordance with federal regulations and CSUN university policies.

I/We certify that all of the information contained within this application is complete and correct to the best of my knowledge.
Student signature:*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Parent/Guardian’s signature:

Clear
(Parent /Guardian signature is required if student is under the age of 24 and is considered a DEPENDANT student)
Date

MonthDayYear
mm-dd-yyyy
Statement of Confidentiality: The information contained in this application is for the purpose of determining the applicant’s eligibility for the Student Support Services Program. All information received is confidential.

Revised June 2022

EOP/TRIO Student Support Services at CSUN is 100% federal funded.

Application for Program Services