TRIO Student Support Services program application

Thank you for your interest in the Augustana TRIO Student Support Services program. Completing an application does not guarantee selection into the program.

Application review will continue until all open student spots are filled.

Here are some things to know before you begin:

It will take approximately 30 minutes to complete this application and you cannot start and save. You may want to review the application, gather all the required information, and then return to submit.
At the end of this application, you will be asked why you want to participate in the TRIO SSS Program.
If you have already earned a bachelor's degree, you are not eligible for this program.
You must be a United States citizen, a US Permanent Resident, or a non-US Citizen eligible for FEDERAL student aid to qualify for this program.

If you have questions about the application, please email triosss@augustana.edu or call 309-794-7815. You can also visit us in person on the third floor of the Olin Center.

Student Demographic Information:

Last Name *

First Name *

Middle Name

Address Line 1 *

Permanent Address 2

Permanent City *

Permanent State *

Permanent Zip *

Email Address *

Cell Phone Number *

School ID *

Date of Birth *

Gender *

Marital Status *

Are you Hispanic/Latino(a)?

Race, Hispanic *

Select one or more races from the following that applies to you. YOU MUST CHOOSE AT LEAST ONE *

Race, American Indian or Alaskan Native *

Race, Asian *

Race, Black or African American *

Race, Hawaiian or other Native to Pacific Island *

Race, White *

Are you a veteran? *

Are you the dependent of a veteran? *

Academic Information:

Have you ever participated in any of the following TRIO programs?

Date you first attended Augustana College: *

Student Status *

Current GPA *

Expected graduation year and semester *

Immediate plans after graduation: *

What are your majors/career goals? *

Eligibility:

Mother's educational background: Choose the highest level completed *

Father's educational background: Choose the highest level completed *

Do you have a disability? *

Did you have either an IEP or a 504 plan in high school? *

Citizenship *

Academic Strategies Questionnaire:

Important to answer honestly. We use these to ensure that we tailor our services to your specific needs.

I would describe my motivation to study on a daily basis as: *

I would characterize my college study habits as: *

I would best describe my confidence to do well in College level work as: *

I would describe my preparedness to do well in college level work as: *

I would describe my ability to select a major and/or career that best fits my interest, skills, and values as: *

I would describe my ability to form clear educational goals as: *

For the items below, we ask that you respond honestly so we can know how our services can best help you.

New ideas and projects distract me from previous ones: *

Setbacks do not discourage me *

I have been obsessed with a certain idea or project for a short time but later lost interest *

I am a hard worker *

I set goals but later choose to pursue different ones *

I have difficulty maintaining my focus on projects that take more than a few months to complete *

I finish whatever I begin *

I am diligent *

TRIO Services:

Please check all of the TRIO-SSS program services that interest you.

Financing college costs

Deciding on a major

Earning good/better grades

Managing personal finances

Tutoring Services

Attending cultural activities

Managing my learning difficulties

Assistance with career choices

Attending college success workshops

Borrowing equipment (laptop, calculator, camera, etc.)

Overcoming test anxiety

Assistance with finding and applying to graduate school

Textbook lending library

Student leadership opportunities

Other assistance you would like

Authorization and Affirmation:

How did you find out about TRIO? *

In your own words, please explain briefly why you want to participate in Augustana's TRIO Student Support Services program. *

Release of information:

I hereby authorize the TRIO SSS Program at Augustana to obtain academic, financial, and other information pertinent to my admission to and participation in the TRIO SSS program. I understand that this information is used to assist in the determination of my eligibility for SSS. I grant permission for the SSS program to gather academic information for follow-up whenever appropriate, including transfer and progress at other higher education institutions. I am aware that my eligibility and financial aid status will be reported to the U.S. Department of Education in accordance with the grant funding regulations. I understand that a copy of my application form will be kept on file in the TRIO SSS office and that the resulting information received from admission and financial aid offices will be kept confidential in compliance with the Family Rights and Privacy Act. I affirm the information I have provided in this application form is true to the best of my knowledge.

The Augustana College TRIO Student Support Services program is funded by a federal grant through the U.S. Department of Education in the amount of $261,888.

Today's Date *

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Signature Type: Simple Start Over

Signature: (Type in your full name)

I agree to the terms included.