Submit Your Application

Thank you for your interest in participating in Eastern Illinois University's TRIO Student Support Services program! Please complete the application and additional forms to the best of your ability, and submit all necessary documentation to the TRIO office after completing the forms. Your application materials and eligibility will be reviewed by our staff, and you will be contacted to schedule an informal interview with our staff to better assess your needs. Please contact TRIO if you have any questions.

______________________________________________________

General Information:

First Name *

Middle Name/Initial

Last Name: *

Other or Preferred Name

Maiden Name (if applicable):

Date of Birth: *

E Number: *

EIU Email Address: *

Personal Email Address:

Cell Phone Number: *

______________________________________________________

Address Information:

Permanent Street Address: *

Apt./Unit/Building/Floor:

City: *

State: *

Zip Code: *

College Street Address:

Apt./Unit/Building/Floor

City:

State:

Zip Code:

______________________________________________________

Demographic Information:

In compliance with the U.S. Department of Education, please state the sex you were assigned at birth: *

Please select one or more gender identifications from the options below that best fits you:

Gender

If you selected Other/Not Listed Here above, please feel free to self-identify:

Please select one or more pronoun identifications from the options below that best fits you:

Pronouns

Are you a U.S. Citizen? *

If you selected No above, are you a permanent U.S. resident?

If you are a U.S. resident, please provide your Alien Registration Number: A-

*(If you have provided your Alien registration number, please upload a copy of both sides of your Alien Registration Card with this application)*

From the options below, please select one or more identifications of race that best fits you. For those identifications that don't fit you, please select No:

American Indian or Alaskan Native *

Asian *

Black or African American *

Native Hawaiian or Pacific Islander *

White *

Other *

If you selected Other, please specify your race identification:

The identifications of Hispanic or Latino may refer to a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race identification.

Regarding your ethnicity, do you identify as either Hispanic or Latino? *

______________________________________________________

Parent/Guardian Information

Relation to Applicant: *

First Name: *

Middle Name/Initial:

Last Name: *

Occupation: *

Highest Level of Education Completed: *

Degree Obtained:

If you selected Other for Degree Obtained, please specify here:

If Applicable, other parent/guardian:

Relation to Applicant:

First Name:

Middle Name/Initial:

Last Name:

Occupation:

Highest Level of Education Completed:

Degree Obtained:

If you selected Other for Degree Obtained, please specify here:

With whom do you live? *

______________________________________________________

Status and Education Information:

What is your Marital Status? *

Are you independent, homeless, or at risk of becoming homeless? *

Are you (or were you at age 13 or older) a ward/dependent of the court? *

Are you a veteran? *

Do you live in a rural community? *

Do you live in a predominately low-income community? *

Are you registered with Accessibility and Accommodations Office at EIU? *

Have you applied for Financial Aid for the current academic year? *

Do you receive financial aid? *

Have you been out of the academic setting for 5 or more years? *

Do you plan to complete you Bachelor's degree at EIU? *

How did you find out about the Student Support Services Program? *

Have you previously participated in a U.S. Department of Education TRIO Program? *

If you selected Yes to having previously participated in any TRIO Programs, please select all that apply below:

Previous Program Participation

If you selected Yes to having previously participated in any TRIO Programs, please specify when and where:

What is your need for academic support in our program? (Please select all that apply below):

Academic Advising

Academic Preparedness for College Level Coursework

Applying to Graduate Schools

Assistance with Educational and/or Career Goals

Career Counseling

Computer Skills

Confidence and Social Skills Building

Faculty/Staff Mentoring Program

Financial Aid Assistance

Financial Independence/Money Management

Graduate School Visits

Increasing Grade Point Average

Interview Practice

Leadership Development

Limited English Proficiency

Multicultural Enrichment Programs

Obtaining Internships

Participating in Summer Research Programs at other Universities

Personal Counseling

Resume Preparation

Scholarship Assistance

Selecting College Courses

Study and Note-Taking Skills

Test-Taking Skills

Tutoring

Other need

What is your anticipated need for tutoring? (Please select all that apply below):

Biology

Business

Chemistry

English/Writing

Foreign Language

Geography

Health Sciences

History

Math

Physics

Political Science

Psychology

Sociology

Speech

Other, please specify:

What are specific ways you expect to benefit from participation in the EIU TRIO Student Support Services Program? *

What is your current year in school? *

What is your major? If not sure, type "undecided." *

What is your minor?

Do you already have a college degree? *

If you selected Yes above, please specify the college degree you have obtained:

What is your current GPA? *

Please select the GPA Scale your GPA is based upon: *

What date was your current GPA earned? *

Please select the school type your current GPA is earned from: *

Please specify the name of the school your current GPA is earned from: *

______________________________________________________

Required Documents and Signatures:

Please review the following statement on proof of income and the application agreement. Then, sign below and submit all relevant documentation.

*If you, your parents, or the parent you live with filed a federal income tax form this current tax year, a signed and dated copy (pages 1 and 2) of the completed U.S. federal income tax return (form 1040, 1040A, or 1040EZ) or other approved proof of income, such as your most current Student Aid Index (SAI), must accompany this application. Faxed copies of the income documentation will be accepted at 217-581-7951 or can be hand-delivered to our office.*

*I understand that the information on this form will be used for statistical and eligibility purposes only and held in strict confidence. All statements are true to the best of my knowledge. I will make every effort to provide TRIO/SSS with documentation of income.*

Applicant's E-Signature *

Please select a signature verification type.

Date: *

Parent's Signature (Only if student is under the age of 18):

Please select a signature verification type.

Date

If applicable, please upload your Income Documentation here:

For second page of Income Documentation, if necessary:

If applicable, please upload both sides of your Alien Registration Card here:

For second side of Alien Registration Card, if necessary:

Have any questions? Please contact the TRIO staff at 217-581-7849 or stop by our office located in McAfee, 1601 4th Street, Room 1125 (North Wing, Lower Level). Thank you for your interest. Please hit submit.