University Of Pittsburgh-Greensburg-SSS-Application Form

Thank you for your interest in Pitt-Greensburg’s TRIO Student Support Services program! Student Support Services (SSS) is a federally funded TRIO program. The program is designed to assist students who are first-generation and/or income-eligible or who have a documented disability in finishing their bachelor’s degree. Please complete this application as thoroughly as possible. You may want to review the questions, take some time to make notes and gather the required information, and then return to submit your application. Required questions are marked with an asterisk (*). Information supplied in this application will be kept strictly confidential and only shared with SSS staff. If you have any questions, please contact the TRIO Staff listed on the main webpage: https://www.greensburg.pitt.edu/academics/trio-sss

Legal Name*

First NameMiddle NameLast Name

Preferred Name/Nickname

Gender ID: *

Personal Pronoun(s):

Date of Birth: *

mm-dd-yyyy

PeopleSoft ID Number: *

Pitt Email Address (list alternative email if unknown): *

example@example.com

Permanent Address:*

Street Address

Street Address Line 2

CityState

Zip Code

Home Phone Number:

(999)999-9999

Mobile Phone Number:

(999)999-9999

Preferred Contact Method

Please check here if you do NOT wish to receive text messages.

I do NOT wish to receive text messages.

Race: Which of the following do you identify as? Check all that apply.*

Please list any language(s) in which you are fluent: *

Marital Status: *

Are you a U.S. Citizen or Permanent Resident?: *

Are/were you active in the United States military?:*

Year of high school graduation or GED attainment:*

Name of high school: *

Are you a former TRIO participant (Upward Bound, Educational Talent Search, Educational Opportunity Center, SSS)? *

If you are a former TRIO participant, please list your program and school/institution:

Current Year in School or Academic Credit Standing *

What are your current or intended college major(s) and if applicable, minor(s):*

Are you a transfer student? (from another college/university)*

If you are a transfer student, please list your previous colleges or universities attended:

Current or Planned Enrollment Status: *

What year do you expect to graduate?*

Please list your current cumulative GPA (for current college students or high school seniors/recent graduates): *

Are you interested in pursuing a degree beyond the bachelor's level? (such as a Master's degree or Graduate certificate)

Do you intend to transfer from Pitt-Greensburg before graduating?*

Employment status while attending Pitt-Greensburg: *

If you participate (or will participate) in Pitt-Greensburg athletics, which sport do/will you play?

Are you a non-traditional student (out of school 5 years)? *

To be eligible for TRIO SSS, students must meet one or more of the following:

- Be a first-generation college student (neither parent or guardian has completed a four-year college degree)

- Meet federal income limit guidelines

- Have a documented disability - documents will need to be filed at Pitt-Greensburg

Also, every applicant must be:

- Enrolled at Pitt-Greensburg

- Enrolled in a 4-year program (bachelor's degree) - Associate Degree programs are NOT eligible.

- The participant must be progressing toward their first bachelor's degree at Pitt-Greensburg. The applicant cannot already hold a bachelor's degree at the time of completing the TRIO SSS application.

- A U.S. Citizen or national of the United States or meets the residency requirements for Federal Student Financial Aid.

- In need of academic support, as determined by Pitt-Greensburg, to successfully pursue a post-secondary educational program.

What is the highest level of education completed by each parent/guardian who raised you?

Parent/Guardian 1*

Did not complete high schoolHigh school diploma or GEDSome college, no degreeAssociate degreeBachelor’s degree (BA/BS)Graduate or professional degree (MA, PhD, JD, MD, etc.)Not applicable / was not raised by this parent/guardian

Parent/Guardian 2*

Did not complete high schoolHigh school diploma or GEDSome college, no degreeAssociate degreeBachelor’s degree (BA/BS)Graduate or professional degree (MA, PhD, JD, MD, etc.)Not applicable / was not raised by this parent/guardian

Prior to the age of 18, did you regularly reside and receive support from ONLY one parent who did not have a baccalaureate degree?*

Do you experience a documented disability? (disabilities can be learning, physical, or psychological) *

If yes, have you registered (or do you plan to register) with Pitt-Greensburg’s Disability Resources? *

If you experience a documented disability, have you ever had an IEP (Individualized Education Plan) and/or a 504 Plan in school? *

Do you authorize Disability Resources to provide accommodation and documentation to support you in the SSS program? *

Are you experiencing homelessness? (i.e., you lack a regular and adequate night-time residence) Or are you at risk of being homeless?*

Have you ever been in foster care or were a dependent or ward of the court?*

Has it been decided by a court of your state of legal residence that you are an emancipated minor or that you are in legal guardianship? *

Do you have children or other dependents for whom you supply more than half of their financial support? *

Have you completed the FAFSA (Free Application for Federal Student Aid) for the current or upcoming academic year? *

Please indicate your dependency status from the FAFSA:*

How do you plan to pay for your college education? Check all that apply:*

Where do you live or plan to live while attending Pitt-Greensburg?*

Parent(s)/guardian(s) actual or estimated Total Taxable Income from the most recently filed tax form. If a Form 1040 form was filed for 2024, refer to line 15 for Taxable Income:

Your actual or estimated Total Taxable Income from the most recently filed tax form. If a Form 1040 tax form was filed for 2024, refer to line 15 for Taxable Income:

Check here if your parents/guardians (dependent students) did not or will not file federal taxes for 2024.

My parents/guardians (dependent students) did not or will not file federal taxes for 2024.

Check here if YOU as an independent student did not or will not file federal taxes for 2024.

I as an independent student did not or will not file federal taxes for 2024.

What academic (or other) barriers do you feel will be challenges to your academic success?*

Comment on your expectations, the benefits you hope to receive, and/or what interests you most about participating in the TRIO SSS Program:*

How did you hear about the SSS Program? Please list information if you were referred by a friend, professor, or staff member.*

What services are you seeking from TRIO Student Support Services? Check all that apply:*

Academic Services (advising, class scheduling, tutoring, etc.)Skill-Building (study skills, time management, test taking, stress management, etc.)Financial Services (financial literacy, budgeting, FAFSA help, scholarship application assistance, etc.)Career Preparation (major/career exploration, building professional skills, assistance with job/internship applications, etc.)Graduate or Professional School Preparation (advising, financial counseling, assistance w/ application process, etc.)Personal Assistance (personal counseling, healthy habits, social connections, campus networking, etc.)Other (Please specify):

If accepted into the TRIO Student Support Services program, I agree:

1) To be an active participant in the SSS program
2) To meet with the SSS staff/faculty on a regular basis each semester
3) To utilize SSS services (such as tutoring, workshops, etc.) that will benefit my academic progress and help me achieve my personal and career goals
3) To read and respond accordingly to SSS emails/phone calls and maintain regular communication with the program staff/faculty
4) To be invested in my education and motivated to graduate

Information Release:

Submitting this application enables Pitt-Greensburg’s TRIO Student Support Services to obtain necessary academic and personal information and records, including grade reports & transcripts, admission; enrollment, financial aid eligibility & awards, U.S. residency status, demographic & contact information, for the purpose of determining eligibility, developing education plans, and recording & collecting program statistics. I authorize TRIO Student Support Services program to use information and photographs related to my program participation in newsletters, web pages, media releases, and other program-related publications. This information may be shared with the U.S. Department of Education, The University of Pittsburgh, and TRIO SSS personnel in accordance with federal regulations and university policy.

Terms of Submission:

By submitting this application, you acknowledge that all the above information is correct and accurate to the best of your understanding. Failure to disclose and submit complete and accurate information may result in the denial of acceptance into the TRIO SSS program.

Applicant Signature*

Pitt-Greensburg TRIO Student Support Services (SSS) Application

General Information

Academic Information

Eligibility Information

Eligibility Questions

Financial Information

Needs Self-Assessment