University Of Alabama-Tuscaloosa-SSS-Application Form

TRIO SSS Application
TRIO SSS Application

Thank you for your interest in our TRIO Student Support Services program! Please complete this application as thoroughly as possible. Note: You cannot save and restart this application. You may want to review the included questions, take some time to make notes and gather the required information, and then return to submit your application.
Full Name*

First NameMiddle InitialLast Name
Preferred Name (if not your first name)
Crimson Email: (@crimson.ua.edu)*
example@example.com
UA CWID:*
Date of Birth:*

MonthDayYear
Date
Gender Assigned at Birth: - We are a federally funded program and therefore required to report data (including sex) to the U.S. Department of Education

MaleFemale
Gender Identity: - It is important to our program that we support all students' experiences. If you identify differently than your assigned sex at birth, and if you would like us to know, please share your gender identity below

MaleFemaleNon-BinaryChoose Not to AnswerOther
What are your pronouns?

He/Him/HisShe/Her/HersThey/Them/TheirsOther
Permanent Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number:
(999)999-9999
Are you Hispanic or Latino? (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race)

YesNo
Race: (You May Select More Than One)

American Indian/Alaskan NativeAfrican American/BlackAsianNative Hawaiian/Other Pacific IslanderWhite/CaucasianOther
U.S. Citizenship status:

U.S. CitizenPermanent ResidentResident Alien who is eligible for federal financial aid
What is your classification according to credit hours earned?

1st Year, Freshman (0-30 credit hours), Never Attended Before1st Year, Freshman (0-30 credit hours), Attended Before2nd Year, Sophomore (31-60 credit hours)3rd Year, Junior (61-90 credit hours)4th Year, Senior (91+ credit hours)5th Year, Other
Are you a transfer student?

YesNo
What is your intended or current major?

Income Information
Financial Aid Dependency Status:

Dependent Student- You live with and/or are supported by parent(s)/guardian(s)Independent Student- You meet at least one of the following: 24 years or older, married, Veteran status, emancipated minor, or have children
Have you completed the FAFSA for the 2024-2025 academic year?

YesNoWill Not Fill Out FAFSA
What was your parent(s)/guardian(s) TAXABLE (not adjusted gross) income amount for 2023?

Disability Verification
Do you have a federally recognized disability?

YesNo
Are you registered with the UA Office of Disability Services?

YesNoIn Progress

Academic Need
(Check all that apply to you)

ACT composite score or any subtest (Math, Reading, Science, Social Science) score of 20 or belowPlaced in MATH 100STEM Major (Science, Technology, Engineering, Pre-Med, Nursing, Math)High School GPA below 3.0High School Equivalent (GED)Limited English ProficiencySAT Verbal Score of 460 or belowSAT Math score of 460 or belowPlacement in MATH 005College cumulative GPA between 2.0 - 2.5Failing grades in one or more coursesNeed for academic support to raise grades in required course(s) or majorNeed help in determining educational or career goalsInadequate high school preparation for college level courseworkReturning adult student (out of the academic pipeline for 5 or more years)Crimson Edge Program
During your last year of high school, approximately how many hours did you spend in a typical week doing the following?
Preparing for class (studying, reading, doing homework, etc.) 0-25
Working for pay 0-25
Participating in co-curricular activities (organizations, school publications, student government, sports, etc.) 0-25
Relaxing and socializing (time with friends, video games, TV or videos, keeping up with friends online, etc. 0-25

During your high school years, how involved were you in the following activities at your school or elsewhere?

	Not At All	Some	Very Much
Performing or visual arts programs (band, chorus, theater, art, etc.)
Student government
Publications (student newspaper, yearbook, etc.)
Academic clubs or honor societies
Vocational clubs (business, health, technology, etc.)
Religious youth groups
Community service or volunteer work

Background Statement
Explain how participating in the TRIO program will contribute to your success in college and help you reach your goals.

Certification
By signing below, you attest that all of the information is accurate and true. You also authorize Student Support Services to retrieve all relevant information to verify eligibility for participation, including admissions, academic, and financial data from all the necessary UA departments.

Clear
Please sign your full name below:
Date

MonthDayYear
Date

TRIO SSS Application