First Name *
Middle Name *
Last Name *
Date of Birth *
School ID *
Local Phone *
Cell Phone Number *
Preferred Contact Method *
Trocaire Email Address *
Street Address *
Local City *
Local State *
Local Zip *
Mailing Address (If Different)
Gender *
Personal Pronouns *
Race *
Ethnicity *
Are you a U.S. Citizen or a National of the United States or a Permanent Resident that would meet the requirements for federal student financial assistance? *
Do you have an earned 4-year (Bachelor) degree, or higher? *
Are You a Veteran? *
Has either of your parents earned a four year degree? *
What type of financial aid are you receiving? Select all that apply: *
Family Income for 2022 as indicated on Line 15 of 1040 Tax Form *
Total Number of Persons in Family in 2022 *
Current or Desired Major *
Status on Enrollment in TRiO *
Expected Year of Graduation *
I have a disability or other health concern for which I may want assistance (i.e., extended test time, note taking, or I had a 504 plan or IEP in the past). *
Do you have a high school diploma or a GED? *
Have you been out of school/college more than five years? *
I would like to develop the following study skills (check all that apply):
Listening and Note-Taking
Organization
Memory/Retention
Test-Taking
Library Usage
Self-Management of Time
Goal Setting
Learning Styles
Test Anxiety
Communication Skills
I would like to develop the following Academic Skills (check all that apply):
Math
Science
Reading
Writing
Using Library Resources
I understand that my financial aid documentation is necessary for admission to the TRIO SSS program at Trocaire. By checking Yes, I release my financial aid information to the TRIO program. *
Signature of Applicant *
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Signature: (Type in your full name)
I agree to the terms included.

Statement of Verification and Disclosure

ACKNOWLEDGEMENTS - Please read each statement below.Your signature below indicates your agreement.

 
  • I certify that the information provided on this application is true and complete to the best of my knowledge.
  • I am aware that the personal information that is provided to the TRiO Student Support Services Program will be protected under the Family Education Rights Act of 1974. No one will have access to the information unless they work with or for the SSS Program, or they are specifically authorized by me to see the information.
  • I authorize TRiO Student Support Services to obtain information pertinent to my participation in the program from college admissions, disability services (if applicable), financial aid, and registrar.
  • I also authorize the SSS/TRiO program to report data of my participation and follow-up with the Student Clearinghouse Tracking System for purposes of the Annual Performance Report required by the U.S. Department of Education for continued funding of the program.
  • Photographs taken during my participation in TRiO activities can be used for TRIO publications and marketing.
  • I understand this authorization may be revoked by me at any time through written communication.
  • I certify that all information provided, including financial and family documentation, in conjunction with this application is true and correct to the best of my knowledge.
  • I acknowledge that I have completed all the necessary steps in the TRiO SSS application process.
  • I understand I must attend an intake appointment with TRiO SSS for my application to be considered.
  • I understand that a TRiO SSS advisor will contact me regarding my admission to the program.