SAN DIEGO STATE UNIVERSITY
STUDENT SUPPORT SERVICES FOR STUDENTS WITH DISABILITIES
Name:
(last)
Student ID #:
Email Address:
May we text you? Yes No
(first)
Cell Phone:
(middle)
If yes, who is your phone carrier?
American Indian or Alaska Native
Caucasian or European Descent
Middle Eastern
Birth Date:
Ethnicity (check the one you most strongly associate with):
Asian
Gender: Female Male
Native Hawaiian or Pacific Islander
Hispanic or Latino
Black or African American
Eligibility Criteria (check all that apply):
US Citizen or Permanent Legal Resident
Disability (medical verification must be on file at Student Disability Services)
First Generation (neither parent has a bachelor’s degree or higher)
Size of
Family
1
Low Income
Level for 2015
$17,655
Based on this chart do you qualify as low income?
Have you applied for financial aid?
2
3
$23,895
$30,135
If no, would you like help in completing the FAFSA?
Yes
Yes
Yes
No
No
No
4 $36,375 Have you received or plan to receive student loans?
5 $42,615
Do you need help in searching for scholarships?
6 $48,855
Are you a client of the Department of Rehabilitation?
Yes
Yes
No
No
Yes No
If yes, are you registered with WorkAbility?
Are you registered with EOP?
Yes No
Yes No
Are there other academic resources other than Student Disability Services that you are using on campus or in the community? If yes, what are they?
Will you give us permission to interact with your professors? Yes No
TRiO SSS Project Page 1 9/14/2015

Major:
When do you plan to graduate?
NEED FOR SSS SERVICES
Minor:
Class level:
What is your career goal?
How can we help you complete your degree? Check all that apply.
Academic Skills: Academic Advising:
Time management Choosing a major
Organization Selecting courses
Test taking preparation
Reading skills
Taking lecture notes
Giving presentations
Learning strategies
Tutoring in math
Understanding degree
requirements
Understanding the syllabus
Interpreting the general catalog
Money Management:
Financial aid advising
Tutoring in writing Seeking scholarships
Tutoring in
Using the library catalog and databases
Research writing
Basic Computer Skills
(Email, Blackboard, word processing)
Communicating with professors
Peer mentoring
Accommodations for disability
Other
Creating a sustainable budget
Identifying budgeting resources
Career Development:
Career exploration
Resume writing
Graduate school advising
Assistants with the graduate school
application
TRiO SSS Project Page 2 9/14/2015

What are your academic strengths and challenges in school?
The above information is true and complete. I understand that this information will be treated as confidential, but will be reported to the U.S. Department of Education as a condition of funding for this federally funded program. Further, I understand that the SSS program for students with disabilities will review my transcript and financial aid information to verify eligibility, determine appropriate services, and track academic progress.
Student’s
Signature: Date:
For Office Use Only
SDS Eligible: _____________________ Disability:
Entry Project: Entry SDSU:
SDSU GPA:
Other:
CUM GPA: Units Completed: WPA:
San Diego State University
Student Disability Services
TRIO – Student Support Services Project for Students with Disabilities
Love Library 205
San Diego, CA 92182-4740
Phone (619) 594-4401, Fax (619) 594-4314
TRiO SSS Project Page 3 9/14/2015

STUDENT PARTICIPATION AGREEMENT
The TRiO program provides comprehensive student support services designed to enhance academic success, persistence, retention, student satisfaction, and graduation from SDSU. The TRiO program has high expectations of its students; to ensure success you must work cooperatively with the TRiO team.
As a TRiO participant you must make a commitment to the responsibilities outlined below:
1.
TRiO participants are responsible for understanding the SDSU catalog and their degree evaluation, which describes graduation requirements. If a TRiO participant does not understand their graduation requirements, they shall meet with the TRiO program advisor.
2.
TRiO participants are required to communicate with the TRiO program advisor at least once a semester to discuss academic progress.
3.
TRiO participants on academic probation must meet immediately with the TRiO program advisor to develop an academic plan for getting off probation.
4.
TRiO participants agree to participate in one or more TRiO SSS program activities each semester.
These activities may include academic advising, peer mentoring, budgeting for college, academic workshops, and tutoring.
5.
TRiO transfer participants need to take the Writing Placement Assessment (WPA) during the first semester at SDSU to be eligible to register for the second semester. TRiO participants must attend the
WPA preparatory workshop offered through the TRiO program.
6.
TRiO participants enrolled in a RWS class need to meet at least once during the semester with a project tutor.
7.
TRiO participants utilizing tutoring shall come to the appointment with the prompt or description of the assignment and any related materials.
8.
TRiO participants new to the TRiO program must meet with a TRiO staff member to discuss options for financing college.
9.
TRiO participants who want help in applying for financial aid, researching scholarships, or creating a sustainable budget shall work with a TRiO staff member.
10.
TRiO participants who are graduating seniors and have taken out student loans must see a TRiO staff member for exit loan consultation.
11.
TRiO participants should inform the TRiO program if they are participating in other SDSU support service programs.
I have read and understand this TRiO Student Participation Agreement and my signature indicates compliance with these conditions.
Student’s
Signature: Date:
TRiO SSS Project Page 4 9/14/2015