2015-2016 TRiO-STUDENT SUPPORT SERVICES APPLICATION
Description
TRiO-Student Support Services (S.S.S) is a college retention and graduation program, which helps students develop the academic skills and personal development necessary to successfully pursue and complete a college degree. Students accepted into S.S.S will be a part of the program until they graduate from P.S.U.
To qualify, students must be income eligible, first generation college students (neither parent has a bachelor’s degree) and/or have a documented disability. In addition, students must also demonstrate academic need.
We only have limited spaces each academic year, so please turn in your completed application as soon as possible.
Contact & Mailing information
TRiO-Student Support Services @ Portland State University
Smith Memorial Student Union #425
1825 S.W Broadway
Portland, OR 97201
Phone: 503-725-3815 Fax: 503-725-5462
Portland State University is committed to providing reasonable accommodations to its students.
TRiO – S.S.S is funded by the United States Department of Education.
Referred by: ______
Program Eligibility:
Students qualify for the TRiO-SSS program by meeting at least one of the following:
§ low-income student (family meets Federal Government Income Eligibility Guidelines and verified by Portland State University)
§ first-generation college student (signifies that parent(s)/legal guardian did not graduate from a 4 year institution)
§ college student with documented disabilities via the Disability Resource Center (D.R.C)
In addition, ALL TRiO-SSS applicants to our program must:
§ be undergraduate students who are admitted full time to Portland State University (12 credits or more per term, no quick admit)
§ be U.S. citizens or permanent residents
§ registered for classes (exception would be Summer Bridge applicants)
§ have fewer than 135 college credits
§ demonstrate academic need
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§
§
1. successful applicants have between a 2.5 - 3.5 college GPA
OR
2. 1st term Freshman students have a 3.0 or higher high school GPA
Selection Process:
When there is limited space in the TRiO-S.S.S program, priority will be given to:
§ Students who are both low income-eligible and first-generation college students
§ Students who are both low income-eligible and have disabilities who require educational accommodation
§ Alumni of other TRiO programs (Upward Bound, Talent Search, Educational Opportunity Center, and Student Support Services from other institutions)
§ MOST IMPORTANTLY, students MOTIVATED to make full use of TRiO-S.S.S services to become a successful P.S.U graduate. It is expected that participants meet with a SSS advisor at least once a term. To be competitive for S.S.S funding, students may be required to meet twice a term with a S.S.S advisor.
Step 1: Please answer these questions about yourself
***PLEASE WRITE USING A BLACK OR BLUE PEN ONLY*******
CONFIDENTIALITY OF INFORMATION
Financial information and all other personal information you give to the TRiO-S.S.S program is sent to the U.S. Department of Education and is protected by the Federal Education Right to Privacy Act. No one may see the information unless they work for Portland State University, TRiO-S.S.S, or if you specifically authorize them to see the information. The information is necessary to determine if you are eligible to participate in the program and helps us to measure your success. The U.S. Department of Education has access to this information to help make TRiO-S.S.S a better program.
Legal Name ______
First Middle Last
Preferred Name ______
PSU Email Address
Permanent Address______
street a.p.t. # city state zip
PSU Student ID Number: ______
Primary Phone: ______
Birthdate: ____/____/____ (mm/dd/yy)
Gender: ______
Grade level at PSU as of: ______(Term and Year)
□ Freshman (0-44 credits) □ Sophomore (45- 89 credits) □ Junior (90-134 credits) □ Senior (135+ credits)
Please check all that apply:
□ H.S. diploma □G.E.D. □Transfer student from ______□ Out of school for more than 5 years
Are you a former TRiO Student? (Upward Bound, Talent Search, Student Support Services, Educational Opportunity Center) □Yes □No
If yes, which program and school? ______
Are you a US Citizen? □ Yes □ No Social Security#_ _ _-_ _-_ _ _ _
If permanent resident or refugee, please enter alien registration number ______
Please have your Resident/Refugee/Alien card with you for identification at the time of your application review.
Racial/Ethnic Background: Please check (√) all that apply
□ American Indian/Alaskan Native □ Asian
□ Black/African-American □ Hispanic/Latino
□ Native Hawaiian or Pacific Islander □ White (Non-Hispanic)
Student Disability Status
Do you have a disability that requires academic accommodations?
□Yes □No
Are you registered with Disabilities Resource Center (DRC) to receive accommodations?
□Yes □No
If yes, do we have your permission to contact the DRC to receive a copy of your accommodation letter?
□Yes □No
Step 2: Please answer questions about your parent(s)/legal guardian(s) and yourself
a. Has either parent/guardian (biological or adoptive) received a baccalaureate degree?
□Yes □No
b. Prior to the age of 18, did you regularly reside and receive support from only one parent who did not have a baccalaureate degree? □Yes □No
Step 3: Please answer these questions about yourself.
a. Are you married (Answer “Yes” if you are separated but not divorced?) □Yes □No
b. Do you have children or other dependents (other than spouse) who receive more than half of their support from you? □Yes □No
c. At any time since you turned 13, were both your parents deceased, were you in foster care, or were you a dependent or ward of the court? □Yes □No
d. Has it been decided by a court of your state of legal residence that you are an emancipated minor or that you are in legal guardianship? □Yes □No
e. At any time on or after July 2014, were you determined to be an unaccompanied youth who was homeless as determined by your high school or district homeless liaison or director of an emergency shelter or transitional housing program funded by the U.S. Department of Housing and Urban Development? □Yes □No
f. Are you serving on active duty (for other than training purposes) in the U.S. Armed Forces? □Yes □No
g. Are you a U.S. Armed Forces veteran who was on active duty & released under conditions other than dishonorable? □Yes □No
Step 4: You must answer the following questions about yourself if you are at least 24 years old or you answered “Yes” to any questions in Step 3.
Your parents/guardians must answer the following questions about themselves if you are less than 24 years old and you answered “No” to all questions in Step 3.
a. What is the total number of persons (including you) in your family? __
b. What was your taxable (not total) income from the last calendar year (2014)? Please check ONLY 1 box and then provide the income information.
ð My family’s taxable income from the last calendar year was $______(taxable income can be found on the federal income tax return. On IRS Form 1040, see line 43. On I.R.S Form 1040A, see line 27. On I.R.S Form 1040EZ, see line 6.)
OR
ð My family did not file a federal income tax return for the last calendar year. My family’s total income from the last calendar year was $______
OR
ð My family had no taxable income during the last calendar year (2014)
Step 5: Attach your unofficial college transcripts if any (including P.S.U). Follow these steps on how to print your P.S.U unofficial college transcripts. ***SSS will retrieve high school transcripts for freshmen with minimal or no college credits.
1. Go tohttp://my.pdx.edu/
2. Click on'Log in to Banweb'
3. Type your Odin Username and Password
4. Click on the'Student Services'tab
5. Click on'Student Records'
6. Click on'View Unofficial Academic Transcript'
7. ClickSubmit
8. On your keyboard, clickCTRL_SHIFT_Pat the same time to print your transcripts
Step 6: Personal Essay - Please type in Microsoft Word a short essay (no longer than 1 page) stating why you are applying to the TRiO-Student Support Services Program. Comment on your expectations, the benefits you hope to receive, and what commitments you are willing to make.
This will also serve as a writing sample, so please revise and edit before turning this in.
Step 7: Federal regulations require that all participants in TRiO-S.S.S demonstrate academic need for program services.
Need Assessment Survey
Please indicate the importance of each service for you during the next year of your academic career
Academic Support
/ Not Important / Not Very Important / Somewhat Important / Extremely ImportantImproving my writing skills / 0 / 1 / 2 / 3
Improving my Math skills / 0 / 1 / 2 / 3
Help passing required science classes (I’m not good at Science) / 0 / 1 / 2 / 3
Help with computer skills / 0 / 1 / 2 / 3
Find out if I have a disability / 0 / 1 / 2 / 3
Help with my disability / 0 / 1 / 2 / 3
Study Skills
/ Not Important / Not Very Important / Somewhat Important / Extremely ImportantLearning to manage my time better / 0 / 1 / 2 / 3
Learning to take tests better / 0 / 1 / 2 / 3
Learning to take notes better / 0 / 1 / 2 / 3
Learning to manage stress better / 0 / 1 / 2 / 3
Learning to use the library better / 0 / 1 / 2 / 3
Educational Planning
/ Not Important / Not Very Important / Somewhat Important / Extremely ImportantDecide on a major / 0 / 1 / 2 / 3
Raise my GPA / 0 / 1 / 2 / 3
Understanding the requirements for graduation / 0 / 1 / 2 / 3
Understanding my major requirements / 0 / 1 / 2 / 3
Understanding the requirements for being admitted to my major / 0 / 1 / 2 / 3
Graduate within ___ years / 0 / 1 / 2 / 3
Career Planning
/ Not Important / Not Very Important / Somewhat Important / Extremely ImportantIdentifying my strengths, abilities, and interests / 0 / 1 / 2 / 3
Identifying careers that match my abilities and interests / 0 / 1 / 2 / 3
Learning about the educational requirements, availability, and income for various careers. / 0 / 1 / 2 / 3
Learning how to create a better resume / 0 / 1 / 2 / 3
Learning how to better my interviewing skills / 0 / 1 / 2 / 3
Get hands on experience with a career/Job / 0 / 1 / 2 / 3
Graduate/Professional School
/ Not Important / Not Very Important / Somewhat Important / Extremely ImportantFind out more about what Grad or Professional school is and if it is right for me / 0 / 1 / 2 / 3
Selecting a graduate/professional school that matches my interests / 0 / 1 / 2 / 3
Learn more about how I get into a graduate/professional school / 0 / 1 / 2 / 3
Preparing for the GRE, MCAT, DAT or the LSAT / 0 / 1 / 2 / 3
Preparing everything necessary for an application / 0 / 1 / 2 / 3
Writing a good personal statement / 0 / 1 / 2 / 3
Social/Personal
/ Not Important / Not Very Important / Somewhat Important / Extremely ImportantLearning how to handle pressure from friends, family, instructors, or myself / 0 / 1 / 2 / 3
Learning how to communicate better with instructors / 0 / 1 / 2 / 3
Feeling more a part of the campus. Meeting more people on campus / 0 / 1 / 2 / 3
Setting goals for the future / 0 / 1 / 2 / 3
Help not procrastinating / 0 / 1 / 2 / 3
Help managing anxiety (test, communication, etc.) / 0 / 1 / 2 / 3
Financial
/ Not Important / Not Very Important / Somewhat Important / Extremely ImportantHelp finding and applying for scholarships / 0 / 1 / 2 / 3
Help applying/reapplying for Financial Aid including work study / 0 / 1 / 2 / 3
Help with loan issues (reducing loan debt, default, etc.) / 0 / 1 / 2 / 3
Do you have a need not listed above?
If accepted into the TRiO-S.S.S program, our expectations of you as a SSS student are:
ü To meet with a S.S.S advisor before the 6th week of each term*.
ü To be competitive for S.S.S funding, students may be required to meet
twice a term with a S.S.S advisor.
ü To be an active participant in S.S.S sponsored workshops/events
ü To read and respond accordingly to S.S.S emails sent to your P.S.U email
ü To be invested in your education
ü To GRADUATE!!!!
*In an effort to support your academic success, students who do not check-in with a SSS advisor before the 6th week of each term (excluding summer) will receive a registration hold. ____ Student’s initials
Step 8: Please read the following statement and then sign and date below.
If you (the student) are less than 24 years old and answered NO to all the questions in Step 3, your parents or legal guardian must also read the following statement and then sign and date below it.
By signing this application, I attest that all information on this application is true and I understand the expectations of the S.S.S program.
I also give my permission to access and release family and student information for the following reasons:
1. TRiO-S.S.S must report student progress and eligibility information to the U.S. Department of Education to demonstrate program effectiveness when requesting renewed funding.
2. At the student’s request to be a reference for employment, scholarship or internship opportunities.
3. Transfer college admission, graduate schools and financial aid offices will waive application fees for students from certain economic backgrounds and will discuss admission and financial aid opportunities with TRiO-S.S.S staff only if we have permission to release student information.