TRIO STUDENT SUPPORT SERVICES

The TRIO Student Support Services program is a federally funded program and collects demographic information for statistical purposes only. TRIO SSS is committed to serving all persons seeking services, and we encourage applications from students of diverse backgrounds. In accordance with the University of Pittsburgh’s nondiscrimination policy, no distinction is made upon the basis of race, color, religion, national origin, ancestry, sex, age, marital status, sexual orientation, gender identity and expression, genetic, information, disability, or status as a veteran.  For the full policy statement, go to hr.pitt.edu/diversity. Demographic data will not be used for determining your eligibility to participate in the TRIO Student Support Services program.

 

Please complete this application as thoroughly as possible.  You cannot save and restart this application.  You may want to review the included items, take some time to make notes and gather the required documents, and then return to submit your application.  If you have any questions, please email Kim Marcellin, TRIO SSS Program Manager at kmarcell@pitt.edu
Last Name *
First Name *
Middle Name *
Date of Birth
Gender
Local/Campus Address Street
Local/Campus City
Local/Campus State
Local/Campus Zip
Cell Phone Number
PItt Email Address
Permanent Address Street
Permanent Address City
Permanent Address State
Permanent Address Zipcode
Personal Email Address
Are you of Hispanic, Latino or Spanish origin? If yes, you MUST aldo identify a "Race" Below
Race/Ethnicity (mark all that apply):
American Indian or Alaskan Native
Asian
Black or African American
Caucasian or White
Native Hawaiian or other Pacific Islander
English is My Second Language?
If yes, what is your first language?
Are You a U.S. Citizen? *
If no, are you a Permanent Resident?
Are You a Veteran?

TRIO SSS Eligibility Requirements

To be eligible for TRIO SSS, students must meet one or more of the following:

  • Be a first-generation college student (neither parent or guardian has completed a four-year college degree)
  • Meet federal low-income guidelines
  • Have a documented disability

    Also, every applicant must be:

  • Enrolled at University Pittsburgh at Bradford
  • Enrolled in a 4-year program (Bachelor’s Degree)—Associate Degree programs not eligible
  • A U. S Citizen or national of the United States or meets the residency requirements for Federal Student Financial Aid
  • In need of academic support, as determined by UPB, in order to purse successfully a postsecondary educational program

 

Consent to Exchange or Request Information to Determine TRIO SSS Eligibility

I give my consent to TRIO Student Support Services (SSS) program staff members to obtain information from the following UPB offices for determination of program eligibility and federal reporting.

(a) Financial Aid

(b) Disability Resources and Services

(c) Admissions/Enrollment Management/Registrar/Academic Affairs / Student Affairs

(d) Athletics/Communications & Marketing

First Generation Eligibility

Does Either Parent (biological or adoptive) have a Baccalaureate (4-year) Degree? (Parent 1 and Parent 2 are required to be answered for eligibility

Parent 1 *
Parent 2: *
Prior to the age of 18, did you regularly reside and receive support from only one parent who did not have a baccalaureate degree? *
At any time since you turned 13, were you an orphan, in foster care, a dependent or ward of the court? *
Has it been decided by a court of your state of legal residence that you are an emancipated minor or that you are in legal guardianship? *
At any prior to the age of 24, were you determined to be an unaccompanied youth who was homeless as determined by your high school or district homeless liaison or director of an emergency shelter or transitional housing program funded by the U.S. Department of Housing and Urban Development? *

Disability Eligibility

(Registration with DRS is required for admittance to TRIO SSS)

If you have not registered, please contact:    

 Carma Horner

814-362-7609

clh71@pitt.edu

Do you have a documented physical, medical, or psychological disability? *
If yes, have you registered with Pitt-Bradford’s Disability Resource and Services? *

Income Eligibility

(PARENT information is required for “dependent” students – i.e. if the student is less than 24 years old, not married, not emancipated, parental income is reported on FAFSA )

(PARENT information is NOT required for “independent” students—i.e. if student is 24 or older, married or emancipated, parental income is not reported on FAFSA)

The Student is Considered *

Choose one(1) of the Following Scenarios

   #! My Parents/Guardians or I filed a 2018 Tax Return
2018 household taxable income (1040—line 43, 1040EZ—line 6, 1040A—Line 27 *
How many people in your household were claimed for 2018 tax purposes *

#2   My Parents/Guardians or I DID NOT FILE a federal income tax return for 2018

Total Income *

#3  My Parents/Guardians or I Had no Taxable Income for 2018

Agree or Disagree *
Prior Participation in a TRIO Program?
Name and Location of Program?

APPLICANT'S ACADEMIC INFORMATION

High School Education

 

High School Attended
Type of High School Award
Year Graduated
Did you attend a College in High School, Bridges, or Dual Enrollment Program?
Are you a college transfer student?
Copy of transcript is attached to application
TRIO SSS is to request transcript fro UPB Enrollment Services
Have you previously received a Bachelor's Degree?

University of Pittsburgh at Bradford Educational Plans


Are you an Incoming UPB Student or a Current UPB Student
UPB Major
UPB Minor, if you have one.
Is your FAFSA submitted?
Are you elgible or do you receive Veteran's Benefits?
Enrollment Status:
Academic Level
Degree Plan at UPB
Future Degree Plans (after UPB)
Will You be Transferring from UPB before Graduating?
Employment Status (while attending UPB):
If you will be participating in UPB athletic, which sport?

CURRENT UPB STUDENTS ONLY

Current Academic Standing
Financial Aid Standing

SHORT ANSWER QUESTIONS

Please provide a response to each of the following two (2) questions.

Minimum/Maximum Words--minimum of 50 words per question

1. Describe how TRIO SSS can help you accomplish your academic goals. *
2. Describe your career goal and how the TRIO SSS program can assist you in achieving that goal

SIGNATURE STATEMENT

The applicant and a parent of the applicant are required to sign the application, below.  These signatures will support that all information above is accurate and truthful to their best knowledge. TRIO SSS eligibility requirements are set by the funding agency--US Department of Education.

Parent E-Signature *
Please select a signature verification type.
Applicant's E-Signature *
Please select a signature verification type.