About TRIO Student Support Services - STEMThe TRIO Student Support Services - Science, Technology, Engineering and Mathematics (STEM) Program at Arizona State University is an educational opportunity federally funded by the U.S. Department of Education. This program serves admitted ASU students who are currently or will be enrolled in an ASU undergraduate program, pursuing their first baccalaureate degree. TRIO Student Support Services - STEM participants are provided with a professional mentor, access to a private and comfortable TRIO study room, free printing, access to calculators, textbooks, field trips, community service opportunities, financial literacy (help with budgeting money), summer experiences where students can get ahead in research, graduate, medical and/or professional school and career plus much more.Thank you for your application. If eligible, you will receive an email or phone call to schedule your first meeting. For more information, contact firstname.lastname@example.org, call 623-543-8121 or visit our office in UCB 220. Applying for * Spring 2019 Summer 2019 Fall 2019 Personal Data Full Name * ASU Student ID# * Local Street Address * City * State * Zip * Home Phone * Cell Phone ASU Email * Academic Information Major * I am a Freshman Transfer Continuing Student (Sophomore, Junior, Senior) Re-entry Student Primary Language English Spanish Arabic Urdu Mandarin Tagalog Vietnamese Other If you selected other, please write your primary language Eligibility I am a * United States Citizen National, permanent resident* Have INS Documentation* * Please provide a copy of documentation Enrollment * I am currently enrolled in an ASU West STEM undergraduate program, seeking my first baccalaureate degree. I am a “first generation” college student – neither of my parents graduated from a 4-year institution 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. Self Assessment What are your needs and/or concerns?(Please check all that apply) Improve writing skills (spelling, grammar, vocabulary) Increase reading comprehension, reading speed, memory Improve math skills and/or reduce math anxiety Improve study habits (note-taking skills, time management) Choosing a major and/or career path Familiarity with campus resources Improve GPA Becoming more involved on-campus Concerned about transitioning to ASU Need assistance completing my FAFSA Afraid of failing in college Out of school too long (5+ years) Health concerns Difficulty meeting new people Limited computer and/or internet skills Unsure of college procedures Difficulty budgeting money May benefit from personal counseling Difficulty participating in discussions Financial concerns Problems at home Limited and/or no support from family/friends How did you hear about TRIO Advisor Friend Instructor/Professor Orientation/Transfer Day TRIO Student Website Other If other, please specify Release of Information * 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 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year201920202021 “**TRIO Eligibility/Enrollment Forms are active for one academic year ONLY.