TRIO Student Support Services Application: Downtown Phoenix

Campus and Program

Downtown

Polytechnic

Tempe

West-STEM

Applying for

Spring 2020

Summer 2020

Fall 2020

Personal Data

Full Name

ASU Affiliate ID

Local Street Address

City

State

Zip

Home Phone

Cell Phone

ASU Email

If you are a dependent student based on financial aid's criteria, please provide the following info:

Parent's full name (First and Last Name):

Parent's email address:

Eligibility

I am a

United States Citizen

National, permanent resident*

Have INS Documentation*

* Please provide a copy of documentation

Are you a first-generation college student?

Yes, I am a “first generation” college student – neither of my parents graduated from a 4-year institution

No, I am not a “first generation” college student

Enrollment

I am currently enrolled in an ASU Downtown undergraduate program, seeking my first baccalaureate degree.

My household meets the federal government’s guidelines for low income.

I am registered with the Disability Resource Center (DRC) and hereby authorize DRC to release records and/or information from my file regarding my disability.

I hereby apply for services in the TRIO Student Support Services Program. I certify that all information supplied by me is correct. I give permission to the TRIO Student Support Services Program staff to check my financial aid and/or I will provide financial information. I give consent for my information, including my name, picture, graduate status, college, major and any awards or scholarships that I receive to be used by the TRIO staff in publications or ASU display cases to promote the success of TRIO students. I authorize the release of my student academic and financial aid records for the program director to use for reporting purposes to the Department of Education.

Student Signature

Date

“**TRIO Eligibility/Enrollment Forms are active for one academic year ONLY.