HomeTrioSSS Online Interest Intake Form Trio SSS ONLINE INTEREST INTAKE FORM TRiO Student Support Services Application Program Eligibility: How would you qualify? (Select all that apply.) * Low Income: Your or your family's taxable income meets SSS federal guidelines, or you are receiving financial aid (Pell Grant). First Generation: Neither of your parents/legal guardians received a four-year degree (bachelors) before you were 18 years old. Disabled: You have a documented disability (physical, psychological, or learning) with documentation on file at the DSU Disability Resource Center. Have you ever participated in a TRiO program? * Educational Talent Search Upward Bound No Personal Information First Name * Last Name * Dixie ID * see your admissions letter Email * Phone Number * Home Mailing Address * Home Mailing Address Home Mailing Address Home Mailing Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal In 100 words or fewer describe how being a part of Student Support Services would benefit you. If you are human, leave this field blank.