TRIO STUDENT SUPPORT SERVICES
2022-2023 APPLICATION
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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.
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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
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Are you of Hispanic, Latino or Spanish origin? If yes, you MUST aldo identify a "Race" Below
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Race/Ethnicity: Mark all that Apply
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American Indian or Alaskan Native
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Black or African American
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Native Hawaiian or other Pacific Islander
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English is My Second Language?
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Are You a U.S. Citizen?
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If no, are you a Permanent Resident?
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TRIO SSS Eligibility Requirements
To be eligible for TRIO SSS, students must meet one or more of the following:
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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
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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
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Prior to the age of 18, did you regularly reside and receive support from only one parent who did not have a baccalaureate degree?
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At any time since you turned 13, were you an orphan, in foster care, a dependent or ward of the court?
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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?
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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?
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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
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Do you have a documented physical, medical, or psychological disability?
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If yes, have you registered with Pitt-Bradford’s Disability Resource and Services?
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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)
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The Student is Considered
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Choose one(1) of the Following Scenarios
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#! My Parents/Guardians or I filed a 2020 Tax Return
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#2 My Parents/Guardians or I DID NOT FILE a federal income tax return for 2020
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#3 My Parents/Guardians or I Had no Taxable Income for 2020
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Prior Participation in a TRIO Program?
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APPLICANT'S ACADEMIC INFORMATION
High School Education
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Type of High School Award
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Did you attend a College in High School, Bridges, or Dual Enrollment Program?
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Are you a college transfer student?
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Copy of transcript is attached to application
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TRIO SSS is to request transcript fro UPB Enrollment Services
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Have you previously received a Bachelor's Degree?
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University of Pittsburgh at Bradford Educational Plans
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Are you an Incoming UPB Student or a Current UPB Student
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Future Degree Plans (after UPB)
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Will You be Transferring from UPB before Graduating?
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Employment Status (while attending UPB):
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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.
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Please select a signature verification type.
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Applicant's E-Signature
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Please select a signature verification type.
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