TRIO Student Support Services STEM Application

Thank you for your interest in our Student Support Services STEM program!  Please complete this application as thoroughly as possible.  You cannot save and restart this application,  so you may want to review the included items and gather any information needed to accurately answer the questions below.

If you have any questions, please call our office at 316-978-3139
General Information:
WSU Id *
First Name: *
Middle Name:
Last Name: *
Date of Birth: *
Address: *
Address 2:
City: *
State: *
Zip Code: *
Cell Phone Number:
Email Address:
Demographic Info:
Ethnicity; Are you Hispanic/Latino

Race: What is your Race? (Check all that apply)
Sex
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian/Pacific Islander
White
Academic Info:
Are you currently enrolled at WSU? *
Do you plan to earn a bachelor’s degree from WSU?
What is your target graduation date (semester/year)?

 

I am enrolling in Student Support STEM for the following reasons: (check all that apply)
Graduate School advising
Personal advising
Academic advising
Tutoring assistance
Financial aid advising
Study skills development
FAFSA application assistance
Scholarship assistance
Financial literacy development
Career advising
Have you previously participated in the following programs: Upward Bound, Talent Search, Upward Bound Math/Science, GEAR UP, Educational Opportunity Centers?
Do you currently participate in the following programs: Student Support Services, Disability Support Services, Veterans Student Support Services?
How did you hear about SSS STEM?
Eligibility Information:
Did your father/guardian complete a four-year college (bachelors) degree?
Did your Mother/guardian receive a four-year (bachelors) college degree?
Did you complete the Free Application for Federal Student Aid (FAFSA)?
Do you include parental income in your FAFSA?
Do you recieve a Pell Grant?
Are you registered with the Office of Student Accommodations and Testing (OSAT)?
Citizenship:
Acknowledgements and Authorization

To the best of my knowledge, all the information provided on this application is true and complete. I understand that TRIO SSS STEM will use the information provided on this form to assist in determining eligibility and all information will be kept confidential. I understand that this TRIO SSS STEM's application is an educational record as that term is defined under the Family Education Rights and Privacy Act (FERPA). 

I authorize TRIO SSS STEM to obtain my academic records, including high school and/or college transcripts, course registration, grades, and other information necessary to provide the services I have requested. 

I give my permission to release my name and/or photo to provide recognition in the TRIO SSS STEM newsletter, website, and other publications, and to Wichita State University staff in the performance of their duties. 

Sign and Submit:
Applicant Signature *
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.