TRIO Achievers Program Application

Thank you for your interest in TRIO Achievers sponsored by Student Support Services.

The TRIO Achievers, federally funded by a grant from the U.S. Department of Education, is focused on improving retention and graduation rates of first-generation, income-qualified students as well as serving students with disabilities. At Cal Poly, we assist and serve at least 250 students each year. 

Services provided include academic advising, tutoring, career information, help with financial aid concerns, workshops, and help understanding academic policies and procedures. We work closely with the Financial Aid Office, Registrar, Student Academic Services, Multicultural Engineering Program (MEP), Academic Skills Center, Career Services, Disability Resource Center and Mustang Success Center. Students who participate in the program literally come from every academic department and major on campus. 

Personal Information
Eligibility
The following information is used to determine eligibility for the TRIO Achievers Program. All information will be maintained in a confidential manner consistent with the Federal Family Education Rights and Privacy Act of 1974.
**Note: First-generation students are defined as having neither parents that graduated from a four year university.
YesNo
Were you born before January 1, 1994?
Are you a veteran of the US Armed forces?
Are you married?
Are you currently, or were you prior to age 18, a ward of the court or orphan?
Do you have legal dependents (other than spouse) who receive more than half of their support from you?
Student Dependent/Independent Status
*If you check "NO" to ALL of the boxes above, you are legally dependent on your parent's income
*If you check "YES" to one or more of the boxes above, you are independent of your parent's income
 
**Note: Income should include yourself and your parents, if you are dependent on your parents’ income; or you and your spouse, if you are married. If you or your parents did not complete an income tax form, record the total of untaxed income for the household during the previous year.
Additional Information
Hold ctrl* for multiple selections
Hold ctrl* for multiple selections
   
Personal Statement
Include any information you feel will assist us in learning as much about you, your interest, and your need for the services provided by TRIO Achievers. Your autobiography may include such things as your birthplace, where you grew up, why you want to participate in TRIO Achievers, how TRIO Achievers can assist you, which services can you benefit from, academic achievements, academic struggles and your goals in life. 
Full Legal Name
I understand that as a participant in TRIO Achievers (also known as Student Support Services), any or all of the academic support services of Student Academic Services (SAS) will be available to me. I understand that all data collected will be kept confidential. By typing my full legal name in the box below and clicking submit, I grant permission to TRIO Achievers to track all of my academic progress at Cal Poly and at any other academic institution. I authorize the release of my student academic, personal and financial aid records for the TRIO Achievers program to use and for reporting purposes to the U.S. Department of Education. In addition, I hereby give my permission for my photograph, work and/or statements to be used by TRIO Achievers for promotional, publicity or instructional purposes. All information provided is accurate to the best of my knowledge. 

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