JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
EMU TRIO Student Support Services Interest Form
To determine eligibility, please complete this form. The information you provide is strictly confidential.
The TRIO Student Support Services (SSS) Program is a federally funded program.
Students wishing to participate must meet specific eligibility guidelines outlined here by the
US Department of Education
. Applicant
must be one of the following
First Generation (parent/guardian did NOT obtain a 4 year degree)
Documented learning or physical di
sability
Low Income (Per the Federal TRIO income guideline)
Updated 6/29/2023
Sign in to Google
to save your progress.
Learn more
* Indicates required question
TRIO SSS Eligibility Criteria
Personal and Demographic Information
Student First Name
*
Your answer
Student Middle Initial
*
Your answer
Student Last Name
*
Your answer
Please mark your current EMU enrollment status
*
Choose
Prospective Student (not enrolled but plan to)
Currently enrolled at EMU
Street Address (and apartment if applicable)
*
Your answer
City/Township
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Primary Phone Number
*
Your answer
Secondary Phone Number
Your answer
Student Personal Email
*
Your answer
Student Emich Email
*
Your answer
EID (Student Number)
*
Your answer
Are you a U.S citizen or Permanent resident?
*
Yes
No
Birthdate
*
MM
/
DD
/
YYYY
Gender
*
Female
Male
Non-Binary
Other:
Race/Ethnicity
*
Hispanic / Latino
Native American or American Indian
Native Hawaiian or Pacific Islander
Black or African American
Asian American
White
Other:
Prior TRiO Experience
Have you ever participated in a federal TRiO program?
Talent Search
Upward Bound
Veterans Upward Bound
Upward Bound Math-Science
Educational Opportunity Center (EOC)
Federal GEAR UP
Other:
Are you planning to live on campus?
*
Yes
No
If you are planning on living campus, are you interested in living in the TRIO Living Learning Community? (Located on the 9th floor of Hoyt Hall).
*
Yes
No
Will you be participating in any other EMU learning communities?
Edge Program
Honors College
McNair Scholars Program
SisterHOOD Initiative
BrotherHOOD Initiative
Returning Citizen Fellowship Program (RCF)
Other:
First Generation Status ( Being a first-gen student means that
your parent(s) did not complete a 4-year college or university degree, regardless of other family member's level of education
.)
Has the parent or legal guardian with whom you reside received a bachelor's (4-year) degree?
*
Yes
No
Disability Status
Do you have any known disability or impairment (learning, physical, emotional, etc.)?
*
Yes
No
Other:
If you answered yes
to the above question, have you registered with the Disability Resource Center (DRC) at EMU?
*
Yes
No
Other:
Did you ever have an Individual Education Plan (IEP) or Behavior Intervention Plan (BIP) at any of your previous schools (PK-12)?
*
Yes
No
Other:
Income Verification
As verification of income, you will be required to provide a signed copy of your federal tax return, or income verification from another governmental source. If you are contacted by our office for an interview, this documentation must be provided at the time of the scheduled interview.
Federal TRIO Program Current Year Low Income Levels
Have you applied for financial aid (completed the FAFSA)?
*
Yes
No
What type(s) of financial aid will you be receiving?
Pell Grant
Scholarship
Federal Work Study
Federal Loans (Ford, Stafford, Perkins)
Other:
Did you or the parent or legal guardian with whom you reside file taxes last year?
*
Yes
No
If answered "Yes" to previous question, please estimate the taxable income for the household in which your reside:
For Example: $36,000; $80,000; $15,000; etc.
Your answer
If answered "Yes" to the question prior to the previous, please indicate the number in the household (size of family unit) for the household in which you reside:
Your answer
Academic Self-Assessment
Which of the following criteria best identifies your reason(s) for wanting to join the EMU TRiO Student Support Services Program learning community?
Make new friends and establish professional relationships with faculty and staff
Maintain high academic performance with access to tutoring and supplemental instruction
Connect with a peer mentor who can help familiarize me with EMU and all of its resources
Learn more about additional scholarships opportunities and financial support
Help with registration and exploring a major
Develop and improve academic skills (study skills, time management, work-school balance, etc.)
Make a successful high school-to-college transition
Other:
By submitting this form, you are certifying that all of the information provided here is true and correct to the best of your knowledge.
*
I agree
Required
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
This form was created inside of Eastern Michigan University.
Report Abuse
Forms
