Loyola University-New Orleans-SSS-Application Form

Q1. If you do not have a Loyola CWID, please skip that question

Name*

First NameMiddle NameLast Name

Preferred Email Address*

example@example.com

Loyola CWID

Date of Birth

mm-dd-yyyy

Q2. How did you hear about us?

Q3. Please choose one or more of the following

Q4. Please choose gender

FemaleMaleNon-BinaryPrefer Not to Say

Q5. Are you a U.S. Citizen?

YesNo

Q6. Are you a Permanent Resident? (Only answer this question if you are NOT a U.S Citizen)

YesNo

Q7. What is your cell phone number? Please include area code.

(999)999-9999

May we send texts to this #?

YesNo

Q8. What is your permanent home street address?

Q9. What is your permanent home city?

Q10. What is your permanent home state?

Q11. What is your permanent home zip code?

Q12. Is English your first language?

YesNo

Q13. Select your classification?

Q14. Are you a transfer student?

YesNo

Q15. Do you have a declared major?

YesNoNot Sure

Q16. What is your major?

Q17. Did parent #1 (biological or adoptive parent) graduate from a 4-year university? (this does not include a 2-year associate's or technical degree)

YesNoNot Sure

Q18. Did parent #2 (biological or adoptive parent) graduate from a 4-year university? (this does not include a 2-year associate's or technical degree)

YesNoNot Sure

Q19. Did you, prior to the age of 18, regularly reside with and receive support from only one parent, and this supporting parent did not receive a 4 -year college degree?

YesNoNot Sure

Q20. Do you have a documented disability?

YesNo

Q21. Are you receiving financial aid this semester?

YesNo

Q22. If you answered yes to Q21, what is your financial aid dependency status?

Dependent Student - I provided my parent's tax information on the most recent FAFSA.Independent Student - I meet one of the following criteria: I am over the age of 24; married; a veteran or active military; have children I support; or am an orphan or ward/dependent of the court.This does not apply to me.I don't know

Q23. SSS programs provide enhanced academic support to its students. Which of the following services do you feel will support you? Check all that apply.

Q24.Were you previously in a TRIO program? If so, which one?

TRIO Upward Bound Math & ScienceTRIO Educational Talent SearchTRIO Student Support Services (Transfer Student)TRIO Upward BoundTRIO Educational Talent SearchI was not in a TRIO program in high school or at a previous institution.I am not sure

Q25. Should you be accepted, does TRIO Student Support Services have your permission to use your image and testimony in media releases for advertising, recruitment, and social media purposes?

YesNo

Q26

The TRIO Student Support Services Program at Loyola is 100% funded by the Department of Education to serve 140 Participants. This program provides opportunities for academic development, assists students with basic college requirements, and helps motivate students toward the successful completion of their post-secondary education.

Eligible students will be contacted by email about the status of their application. Please email Ms. Monica Curtis, Director for Student Support Services (TRIO), at triosss@loyno.edu if you have questions.

Q27. By entering my name and date in the space below, I am certifying that all the information I have provided is correct and true to the best of my knowledge. I furthermore release permission for the TRIO Staff members to access any academic and financial aid and/or financial records through the college financial aid office for me and/or my parent for program eligibility.

Signature

Date

mm-dd-yyyy

TRIO Student Support Services Application for Loyola University New Orleans