University Of California-Irvine-SSS-2025 Application Form

University Of California-Irvine-SSS-2025 Application Form
TRIO Scholars - SSS Program Application
TRIO Scholars is a federal program funded by the U.S. Department of Education. The TRIO Scholars Program provides opportunities for academic, professional, and personal development and assists students with navigating the university. The goal of the TRIO Scholars program is to help their participants be successful at UCI and beyond.

Students are accepted into the program based on 1) eligibility criteria, 2) demonstrated academic need, and 3) space availability.

Completion of the application does not guarantee acceptance into the program.

To be eligible for the Student Support Services Program, (TRIO-SSS) students must meet all the following criteria:
- Show a need for academic support
- Be a U.S. citizen or permanent resident
- Must meet one or more of the following criteria:
  - First generation college student criteria (the student's parents or legal guardians have not completed a 4-year college degree)
  - Meet low-income levels outlined here https://www.ed.gov/about/ed-offices/ope/trio/federal-trio-programs-current-year-low-income-levels
  - Have a documented disability
Application Checklist:
- Official Application
- Page 1 of your parents 1040 tax forms if you are a dependent or page 1 of your 1040 tax forms if you are independent*
- Optional: copies of your entrance exams (UCI Placements Scores, SAT, ACT,etc.)
*Dependent and Independent Definitions:
Independent Students are either age 24+, married, emancipated minor, veteran, or parent providing over half of child(ren)’s support
Dependent Students are either younger than 2: Your parents' tax information is reported on the FAFSA.

SECTION 1 - Student Information
Name*

First NameMiddle NameLast Name
Preferred First Name
Sex*
Date of Birth*

MonthDayYear
Date
UCI NetID (e.g. Peter Anteater, UCInetID: panteate):
UCI Email*
example@example.com
Local Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Permanent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
(999)999-9999
Major
Do you plan to be enrolled Full Time in the fall?
Are you a transfer student?
Do you work? If yes, how many hours?
Is English your first language?

SECTION 5 - Household Income and Size
Did you answer NO to all of the Dependency Information questions above? Complete the following with your PARENT/GUARDIAN tax filing information. A parent or legal guardian’s written signature is required.
Did you answer YES to any of the Dependency Information questions above? Complete the following using YOUR tax filing information.
Did You or Your Parent/Guardian file a Federal Tax Return?*
Household Size (Including Yourself)*
Taxable Income Amount (line 15 of your 1040 form):*

SECTION 6 - Academic Needs Assessment

Please rate your current level of confidence or ability in the following areas. This helps TRIO staff assess your academic support needs.*

	1 - I need a lot of help	2 - I need some support	3 - Neutral	4 - I feel mostly confident	5 - I feel confident
Major Selection
Degree Planning
Course Selection
Raising College Grades
Time management
Academic Learning Skills
Writing Assistance
STEM Tutoring
Test-taking Skills
Academic Skills
Locating Campus Resources
Study skills (e.g. note-taking, test prep)
Financial Knowledge
Budgeting Skills
Finding & Applying to Scholarships
Financial Aid Application
Financial Aid Advising
Finding internships or jobs
Exploring career options
Career Goals Guidance
Resume/Cover Letter Assistance
Interview Preparation
Researching graduate programs grad/professional school
Graduate or Professional School Preparation
Graduate or Professional School Application
Feeling connected to peers/community
Mental/emotional wellness

How do you think TRIO SSS can help you achieve your academic goals?*
Is there anything else about your background or academic trajectory you would like to share with the selection committee?
Upload a copy of 1040 Tax Forms here (PDF or JPEG form only). Please blackout social security numbers*

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Optional. Upload a copy of your placement exam

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Signature - Affidavit of Truth and Certification of Release of Information*

Clear
All signatures acknowledge and indicate an agreement and understanding of all information and the statements provided throughout this application are true and accurate to the best of the applicant and signee(s) knowledge.
All signatures indicate authorization to release the applicant's student records to the TRIO SSS staff for the purposes of assessing the applicant's need for services, monitoring academic progress, evaluating program effectiveness, fulfilling program-reporting requirements, and advocating on behalf of the applicant with UCI campus partners. All signatures on this document are valid as if signed in writing.
Notice: A parent or legal guardian’s signature is required if the applicant is admitted to UCI as a dependent student and/or is under 18 years of age