TTU SSS is a federally-funded TRIO program
($220,000 annually for 5 years) under the
U.S. Department of Education.
Please complete all questions on the application and return to TTU Doak Hall 120 or trio.sss@ttu.edu
CONTACT AND BASIC INFORMATION
Application Date: ____________________________
R# ____________________________
Date of Birth: _________________________________
Age: __________________ Gender:__________________________________________________
Full Legal Name: Last: _________________________________________________ First: ____________________________________ Middle Initial: _______
What do you wish to be called? (If different from legal name): ______________________________
Check only one:
□ U.S. Citizen
OR
□ Permanent Resident OR
Check all that apply: □ American Indian/Alaska Native
□ White
□ Pacific Islander
□ Asian
□ More than one race
□ Other: _______________________________________
□ Black or African American
□ Latino or Hispanic
□ Other: ________________________________________________________________
Local Address: ____________________________________ City: _____________________________________ State: _______ Zip Code: __________________
Permanent Address: __________________________________________ City:_________________________ State:______ Zip Code: __________________
Cell Phone #: ___________________________ Home Phone #: ______________________________ Work Phone #: _______________________________
Parent Phone #: __________________________ Parent Name: ______________________________ Language Preference: ________________________
TTU E-mail:_________________________________________________________________________________________________________________________________
Personal E-mail: ___________________________________________________________________________________________________________________________
Best Method of Contact: □ Home phone
□ Cell phone
□ Work phone
Do you have a documented physical or learning disability?
□ Yes
□ TTU Email □ Personal Email
□ No
If yes, please specify: _________________________________________________________________________________________________________________________
Have you met with Student Disability Services (SDS)?
□ Yes
□ No
How did you hear about TTU SSS? _________________________________________________________________________________________________________
Are you a former TRIO student?
□ Yes
□ No
If yes, what program? ___________________________________________________
The financial and non-directory educational record information on your student account is confidential and protected by the
Family Educational Rights & Privacy Act (FERPA). FERPA is also knows as the Buckley Amendment, Statute 20 U.S.C. 1232 (g),
regulations 34 CRF Part 99. We cannot release information to another person without your written authorization.
PLEASE CONTINUE TO NEXT PAGE.
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EDUCATIONAL & CAREER INFORMATION
Have you received your: □ High School Diploma
□ GED Diploma
Date Graduated:__________________ GPA _______
Date Completed:__________________
Have you previously attended college: □ Yes
□ No
If yes, which institution? _______________________________________________
Did you graduate from this institution? If so, with what degree? _______________________________________________________________________
Classification: □ Freshman (<30 credits)
□ Sophomore (30-59 credits) □ Junior (60-89 credits)
Do you plan to receive your bachelor’s degree at TTU?
□ Senior (>90 credits)
□ Yes □ No
Current Enrollment Status: □ Part-Time (<12 credit hours) □ Full-Time (>12 credit hours)
Do you plan to pursue post-graduate work after completing your bachelor’s degree? □ Yes
□ No
Career Goal- My career plans are: □ Undecided □ Decided, please specify:
_________________________________________________________________________________________________
ACADEMIC & SUPPORTIVE SERVICES NEEDS ASSESSMENT
Check all areas in which you feel SSS staff may be able to assist you:
□ Academic Coaching--Receive assistance in choosing classes to stay on track to graduate on time.
□ Career Counseling--Receive support in determining the best college major and career for you.
□ Tutoring--Receive personal one-on-one tutoring in select subject areas at no cost to you.
□ Financial and Economic Literacy--Learn about managing a budget and making wise financial decisions.
□ Learning Styles and Study/Test Taking Skills--Assistance in identifying your style of learning and some strategies to study
and take tests successfully.
□ Graduation & Enrollment in Graduate School--Receive assistance in graduation from TTU & graduate school enrollment.
□ Financial Aid Information & Assistance Applying--Assistance completing FAFSA annually. Learn about scholarships &
other financial aid options.
FINANCIAL AID AND DEPENDENCY STATUS
Are you receiving financial aid this semester? □ Yes □ No
If yes, what is your dependency status?
□ Independent Student
□ Dependent Student
□ Don’t Know
By signing this application, I attest that all the information is true. Moreover, I authorize the release of the my academic and
financial records to TRIO-SSS, understanding that the information on these records will be used only to assess my need for
Project services, monitor my educational process, and fulfill program reporting requirements.
_____________________________________________________________________
Student’s Signature
______________________________________
Date
Please proceed to the next page. ONLY complete ONE of the following Educational Attainment & Income Forms
(Dependent OR Independent) NOT BOTH FORMS
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DEPENDENT STUDENTS ONLY
2015-2016
To Be Completed and Signed by the Student’s Parent/Legal Guardian
Student’s Name: _____________________________________________________________________________________________________________________
Name of Parent/Legal Guardian: __________________________________________________________________________________________________
Parent Phone No.: ________________________________________
Parent Email Address: _____________________________________________
Did Mother of Student earn a 4-year degree from a college/university? □ Yes □ No
Did Father of Student earn a 4-year degree from a college/university? □ Yes □ No
Number of people living in parent/legal guardian’s household? _______________________
What was parent/legal guardian’s 2014 TAXABLE* INCOME? $________________________
* This is NOT adjusted gross income and is listed on the 2nd page of most tax forms. For example: IRS Form 1040, see line 43;
on IRS Form 1040A, see line 27; on IRS Form 1040 EZ, see line 6.
My family did not file a federal income tax return for the last calendar year, but my family’s taxable income from the last
calendar year was: $______________________
All of the information on this form is true and complete to the best of my knowledge.
_____________________________________________________________________________
Parent/Legal Guardian Signature
_________________________
Date
DEPENDENT STUDENTS ONLY
For assistance with the application:
TTU TRIO Student Support Services
2518 15th St. Lubbock, TX 79409
Office: 806-742-3629 Fax: 806-742-0983
trio.sss@ttu.edu
https://www.depts.ttu.edu/triosss/
TRIO OFFICE USE ONLY
Rec’d by:________________________
Date Rec’d:_________________
ONLY complete ONE of the Educational Attainment & Income Forms (Dependent OR Independent)
NOT BOTH FORMS
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INDEPENDENT STUDENTS ONLY
2015-2016
To Be Completed and Signed by the Student
Student’s Name: _____________________________________________________________________________________________________________________
ID #: __________________________________________________________________________________________________
Phone No.: ________________________________________
Email Address: _____________________________________________
Did Mother of Student earn a 4-year degree from a college/university? □ Yes □ No
Did Father of Student earn a 4-year degree from a college/university? □ Yes □ No
Number of people living in student’s household? _______________________
What was the student’s 2014 TAXABLE* INCOME? $________________________
* This is NOT adjusted gross income and is listed on the 2nd page of most tax forms. For example: IRS Form 1040, see line 43;
on IRS Form 1040A, see line 27; on IRS Form 1040 EZ, see line 6.
My family did not file a federal income tax return for the last calendar year, but my taxable income from the last calendar
year was: $______________________
All of the information on this form is true and complete to the best of my knowledge.
_____________________________________________________________________________
Student’s Signature
_________________________
Date
INDEPENDENT STUDENTS ONLY
For assistance with the application:
TTU TRIO Student Support Services
2518 15th St. Lubbock, TX 79409
Office: 806-742-3629 Fax: 806-742-0983
trio.sss@ttu.edu
https://www.depts.ttu.edu/triosss/
TRIO OFFICE USE ONLY
Rec’d by:________________________
Date Rec’d:_________________
ONLY complete ONE of the Educational Attainment & Income Forms (Dependent OR Independent)
NOT BOTH FORMS
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