Georgia Southern University-DSSS-Application Form

Application for Georgia Southern University TRIO Student Support Services: Disabilities Statesboro/Armstrong/Liberty Campuses
*Please Note: If you have earned a 4 year college degree (Bachelors) you do not qualify for this program. If you are already a student in TRIO SSS serving Armstrong/Liberty campuses, you do not qualify for this program. To apply to this program, the Statesboro, Armstrong or Liberty Campus must be your home campus.

Georgia Southern University • Statesboro/Armstrong/Liberty Campuses • TRIO Student Support Services: Disabilities

5539 Forest Drive • Suite 1313 • Statesboro, GA 30458

sssd@georgiasouthern.edu

Georgia Southern University's TRIO Student Support Services: Disabilities Project is a U.S. Department of Education TRIO Program and is 100% supported from 2025 - 2030 in Federal funds each year.
Have you earned a 4-year degree?
(Students who are enrolled as Fully Online students, are not eligible to apply for TRIO SSSD)
What is your home campus?
Full Name

First NameLast Name
Permanent Mailing Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
My permanent and local address are the same.
Are you living on campus?
What is your Georgia Southern email?
example@example.com
What is your Eagle ID (900) number?
What is your birth date?

MonthDayYear
mm-dd-yyyy
Are you Hispanic/Latino?
What is your race?

Other
What is your cell telephone number?
(999)999-9999
What is your permanent phone number?
(999)999-9999
Gender Identity (Optional - for program reporting purposes only)

Prefer to self-describe
Are you a U.S. citizen?
Are you a transfer student?
What's your major?
GPA
Has your mother received/earned a 4-year college degree?
Has your father received/earned a 4-year college degree?
Have you participated in a TRIO Program? (TRIO Educational Talent Search, TRIO Upward Bound, TRIO McNair, TRIO Student Support Services)

Other
Do you have a documented disability that requires accommodations?
If yes, are you registered with the Student Accessibility Resource Center (SARC)
Student Financial Information
Directions: This section requires the student to prove their family's financial information.
- If you are 24 years or older and considered an independent student, you may complete the remainder of the application on your own.
- If you are 24 years old or younger and considered a dependent student, your parent(s) or guardian(s) should help complete the Questions about household income, after which the student can complete the rest of the application on their own.
Are you over the age of 24?
Which parent did you regularly reside with and receive support from during your childhood (i.e. until you were 18 years old)?
What is the total number of persons in your household?
What was your family's taxable income (not total income) from the last calendar year?
Did your family file a Federal income tax return last year?
If accepted into the TRIO program, which of the following services do you need? ( Academic advising is provided to all TRIO participants as part of the program)

Other
I need tutoring in:
In no less than 250 words, please indicate why you are applying to the TRIO SSSD program. Comment on your needs, what you hope to gain, and what commitments you are willing to make to succeed at Georgia Southern University and as a TRIO Participant. *You may attach a separate sheet if you need to.*
Separate sheet for essay (if needed):

Cancelof
Date

MonthDayYear
mm-dd-yyyy
Dependency Override Forms:

Cancelof
Please read the following statement then sign using your mouse and date below.

Signature of Student's Parent or Legal Guardian (If under the age of 24 your parent or legal guardian must sign this application. Please save your application, skip the "create an account" and provide your parent's email or get a shareable link. The form will be sent to that email. Your application is not valid until he/she signs and submits it.

Please read the following statement then sign using your mouse and date below.

Please read the following statement then sign and date below. Signature(s) attest to the accuracy and truthfulness of the information provided within this application. You will be notified if additional information is needed to process this application.

I give Georgia Southern University TRIO SSSD permission to obtain any academic or personal information that is necessary for providing assistance to me, evaluatina the effectiveness of the program, and fulfiling Federal and University reporting requirements. This information may be obtained from University departments and/or personnel, including but not limited to. Georgia Southern faculty, Undergraduate Admissions, Office of Financial Aid, Student Accessibility Resource Center. Dean of Students, etc.
Signature of Student's Parent or Legal Guardian (if less than 24 years of age)
Student's Signature
Date

MonthDayYear
mm-dd-yyyy
We thank youfor your time spent taking this survey.
Your response has been recorded.

Application for Georgia Southern University TRIO Student Support Services: Disabilities Statesboro/Armstrong/Liberty Campuses

Student Financial Information