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. Preference is given to students who meet two of the three eligibility requirements) * Low Income: Your or your family's taxable income meets SSS federal guidelines, or you are receiving federal 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 Utah Tech 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 AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming 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.