California State University-Channel-SSS-Application Form

  • CSU Channel Islands TRIO Student Support Services (SSS) Participant Application

  • Thank you for your interest in the TRIO Student Support Services (SSS) program at CSU Channel Islands. This federally funded program supports eligible students who are first-generation, low-income, and/or have a documented disability. Please complete all sections of this application accurately and thoroughly. Information will be kept confidential and used only to determine eligibility.

    Application Checklist:

    · Application

    · Signed Income Verification (1040 tax form) or Income Verification Form – ADD Link to Form

    · Disability Verification (if reporting a disability)

    As a reminder, to be eligible for TRIO SSS, you must be a CSUCI undergraduate who:

    · Is a US Citizen or Permanent Resident

    · Demonstrates academic need for project services

    AND who identifies as at least one of the following: 1. Low-Income based on U.S. Department of Education federal income guidelines

    2. First-Generation college student (neither parent has completed a 4-year college degree)

    3. Individual with a documented disability

    Students are accepted into the program based on eligibility criteria, academic need, and space availability. Completion of the application does not guarantee acceptance of the program.

    California State University, Channel Islands TRIO SSS is 100% federally funded. Admission into CSUCI TRIO SSS is open to those who meet the eligibility criteria, regardless of gender, race, national origin, color, age, religion, or disability.

    CONTACT US | If you have any questions, please call our office at 805-437-8939 or email us at triosss@csuci.edu.

    • Section 1: Personal & Contact Information  
    • Date of Birth:
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    • Section 2: Eligibility Verification  
    • Please check all that apply:
    • Section 3: Academic Background  
    • Class Level:
    • Have you previously participated in any TRIO program (e.g., Upward Bound, Talent Search, SSS, EOC, McNair, Gear Up)?
    • Section 4: Academic Need Assessment (Selection Matrix Factors)  
    • Please check any factors that apply to your academic situation. These are used to assess academic need in accordance with the SSS Participant Selection Matrix.
    • Section 5: Personal Statement  
    • Section 6: Authorization & Verification  

    • I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that falsifying or omitting information may result in disqualification from the TRIO SSS program. I authorize the CSUCI TRIO SSS program to verify my eligibility and access academic and financial aid records for program purposes.

    • Clear
    • Date
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    • Clear
    • Date
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