SSS/TRiO Application
Walla Walla Community College
Full name (include middle initial): __________________________________________________________
Preferred nick name: ________________ Previous last names: ___________________________________
Local address: ___________________________________________________________________________
Street address/City/Stat/Zip
Permanent address: _______________________________________________________________________
(fill in info if different that local address)
Local phone: __ __ __ - __ __ __ __
Street address/ City/ State/ Zip
Cell phone: __ __ __ - __ __ __ - __ __ __ __
e-mail address (not your WWCC email):______________________________________________________________________________
Student I.D. number: __ __ __ - __ __ - __ __ __ __
Marital Status: Single__
Married __
Ethnic Group
__ Asian
__ American Indian or Alaskan Native
Divorced __
Birth date: ___/___/___
Separated __
Gender: M__ F__
Widowed __
Please check all ethnic groups that apply to you.
__ Black or African American
__ Hispanic or Latino
__ White
__ Native Hawaiian or Pacific Islander
Eligibility Info
Are you a United States citizen?
Yes __ No __
If not, are you a Permanent Resident? Yes __ No __ Resident Alien Number: ___________________
Does either of your parents have a bachelor’s degree (4 year college degree)? Yes __ No __
Financial Info
Are you receiving college financial aid? Yes __ No__ My financial aid paperwork is in process __
If you are under the age of 24, single, or do not have a child, you are considered a dependent student.
Given the information provided above, do you consider yourself: Dependent___ Independent___
Family size consists of relatives receiving more than 51% financial support from you or your parents (for
dependent students), even if they live outside your household.
Given the information provided above, what is your family size? ____
Using the following table and last year’s tax return, what is your taxable family income?
(dependent students must use parent’s tax information)
Form 1040
Form 1040 EZ
Form 1040 A
Telefile
Did not file taxes
Line 43
Line 6
Line 27
Line K
Last Year’s Taxable Income
$
$
$
$
Check all income sources (how you are funding living expenses) below that apply to you:
__ Dept of Voc Rehab
__ Child support for dependent children
__ Financial aid (inc. work study & loans)
__ Food stamps
__ Labor & Industries injury claim
__ Living with parent/relative
__ Parents/guardian/relative
__ Savings
__ Spouse is employed
__ Social Security benefits
__ TANF (public assistance)
__ Veteran’s benefits
__ Workforce Training funds
__ Opportunity Grant
__ Scholarships (list all): _________________________________________________________________
__ Employment—if so where_____________________________________ # hours worked per week ___
__ Other—explain: _____________________________________________________________________
Special Needs
Do you have a documented disability?
Yes __ No___
If yes, have you self-identified through our DSS Office (Student Dev. Center)?
Yes __ No___
Are you receiving care or treatment from any agencies or doctors? Yes__ No__
If so, list doctors and/or agencies: ____________________________________________________
Education Information
Name of last high school attended: _________________________________________________
Did your high school program include college preparation courses? Yes __
No __
College History:
College GPA? _____
How many credits have you completed? ___
Have you ever been on financial aid probation?___
Have you withdrawn from classes after the first two weeks? _______
Education achieved to date
(check all that apply)
Year Graduated
Name of School
_____
GED
__________
______________
_____
High school diploma
__________
______________
_____
Some college (but no degree)
__________
______________
_____
Certificate (vocational)
__________
______________
_____
AA, AS or AAAS
__________
______________
_____
Bachelor’s degree
__________
______________
Enrollment status at WWCC
_____ Currently enrolled
_____ Not currently enrolled, but will be next quarter
Check one: I plan to be enrolled… full time each quarter __
(12 or more credits)
¾ time__
(7-11 credits)
part time __
(6 credits)
TRiO members must be pursuing an associate degree and planning to transfer to a four-year college
afterwards. What WWCC degree(s) are you pursuing? Check all that apply
__ Associate in Arts Degree (AA transfer degree)
__ Associate Degree in Nursing (ADN)
__ Assoc. Applied Arts & Sciences (AAAS pro tech degree)
__ Associate in Science (AS transfer degree)
Occupational goal:_____________________________________________________________________
Have you taken the college placement tests? Yes__ No__
What year do you plan to graduate and transfer from WWCC? _____________________________________
Have you attended other colleges? Yes __ No __ Where? ______________________________________
Names of other schools you are interested in attending after leaving WWCC:__________________________
Contact Person: (List a relative with whom you do not live)
Name: ___________________________________________________________________________
Relationship to you: ________________________________________________________________
Phone: __ __ __ - __ __ __ - __ __ __ __ Email: __________________________________
____________________________________
Applicant’s signature
Date: _____________________________
This application is filled out to the best of my knowledge. I understand all information I share with the
SSS/TRiO staff will be kept strictly confidential. I understand that information from other offices at WWCC
may be requested to complete my SSS/TRiO file.
Incomplete applications will not be accepted.
Applicant—keep this page for your reference.
Below is a listing of the services TRiO provides:
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Academic advising
Book loans (when available)
Campus visits to 4-year colleges
Career counseling
Computer use in TRiO area
Computer/laptop loans (when available)
Cultural enrichment activities
Digital tape recorder loans (when available)
Emergent need grants (depending on eligibility and availability)
Financial aid planning/monitoring
Personal advising
Scholarship search
Prescriptive transfer planning
Tutoring (if tutors are available)
TRiO Club (social enrichment)
Workshop
TRiO Admission Checklist:
Submit completed TRiO application to the TRiO program.
Applicant will be called for an interview or sent a letter explaining why they won’t be interviewed.
Meet with a TRiO advisor to discuss program services and to verify eligibility.
Attend a group orientation session or individual orientation session.
Complete program assessments.
Meet with advisor to review assessment results; complete TRiO enrollment paperwork, receive TRiO
flashdrive and have photo taken for TRiO file.
Appointment made to create the Transfer Success Plan.
After completing the steps above student is enrolled in TRiO and eligible to access TRiO services.
Rev: summer 2012