CMU TRIO SSS Application

Which program are you applying for? *

How did you hear about the TRIO SSS Program? *

Basic Information

School ID *

First Name *

Last Name *

Name Used *

Today's Date *

Pronouns *

Gender *

Date of Birth *

Age *

Marital Status *

Do you have children? If so, how many?

Address Information

Local Address *

Local Address 2 *

Local City *

Local State *

Local Zip *

Local Phone *

Permanent Address *

Permanent Address 2 *

Permanent City *

Permanent Zip *

Permanent Phone *

CMU Email Address *

Personal Email *

Preferred Method of Contact *

How would you describe your race/ethnicity?

Please select yes or no to the following

Native or Indigenous American *

Asian *

Black or African American *

Hawaiian or Pacific Islander *

Hispanic *

White *

Emergency Contact Information

Name *

Relationship *

Phone *

Program Eligibility

Are you a military veteran? *

Were you previously in foster care? *

Are you currently foster youth? *

Are you currently homeless? *

Is English your second language? (ESL) *

Are you an individual with a disability that fits the definition below?

ADA Amendments Act of 2008 defines this as a person whom:

(a) has a physical or mental impairment that substantially limits one or more major life activities which also include learning, reading, concentrating, thinking, communicating, etc., and
(b) has a record of such an impairment, or
(c) is regarded as having such an “impairment.”

Do you have a Documented Disability that fits the above criteria? *

Did either a parent or legal guardian graduate with a 4-year Bachelor's Degree? *

If yes, did the parent or legal guardian that you primarily resided with until you were 18 years of age graduate with a 4-year Bachelor's Degree?

Please mark one of the following:

U.S. Citizen

Permanent Resident

Neither

Educational History

Did you recieve your high school diploma? *

If not, have you earned your GED?

Year of High School Graduation or GED *

Cumulative High School GPA *

ACT Composite Score

SAT Combined Score

Are you enrolled in any other SSE program at CMU? *

How many semesters have you completed at CMU? *

What is your current/desired major? *

How many credits are you currently registered for? *

Financial Information

Independent or Dependent Status

Independent individuals: (1) Are married, or (2) are over the age of 24, or (3) have served in the military, or (4) have a child, or (5) were in Foster Care at the age of 13 or older.

Dependent Individuals: (1) Are not a parent, and (2) are not married, and (3) are under the age of 24, and (4) have not served in the military.

If you are a dependent, your parents will have to fill in and sign the financial portion of this application.

Please mark the appropriate response.

I am an independent

I am a dependent

Are you currently receiving Financial Aid through Colorado Mesa University? *

Have you completed the FASFA for the current school year? *

Number of people (yourself included) residing in your household? *

Please indicate your family's 2022 (household) Taxable Income range: *

Has your financial situation changed since 2022? *

Note: taxable income can be found on the federal income tax return - IRS Form 1040, see line 43; on IRS Form 1040A, see line 27; on IRS Form 1040 EZ, see line 6.

By signing this application, I attest that all the information, including federal income tax amount, is true and for the most current years taxes. Moreover, I authorize the release of the student’s academic records to TRIO-SSS, understanding that the information on these records will be used only to assess the student’s need for the program, services, discern the student’s educational process, evaluate the effectiveness of program activities, and fulfill program reporting requirements.

Student Signature *

Signature Type: Simple Start Over

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Signature: (Type in your full name)

I agree to the terms included.

Date *

Parent/Legal Guardian's Signature - Required if student is a dependent