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Home > Student Life > TRIO Student Support Services > TRIO Application

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- TRIO Application
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TRIO Application

Term*
Name (First, Middle, Last)*
NIACC Student ID*
Hidden
Last 4 of Social Secuirty #*
Hidden
Birthdate*
Month
Day
Year
Address while attending school*
Street Address City State ZIP Code
Cell Phone
Hidden
Alternate Phone
NIACC Email Address*
Enter Email Confirm Email
Are you a citizen of the United States or permanent resident?*
- Yes
- No
Are you of Hispanic or Latino origin?*
- Yes
- No
Have you been a foster youth or homeless after the age of 13?*
- Yes
- No
How would you best describe yourself?*
Mark all that apply
- American Indian/Alaska Native
- Asian
- Black/African American
- Native Hawaiian/Pacific Islander
- White
Do you have a diagnosed disability?*
- Yes
- No
If yes, check all that apply*
- Prefer Not to Disclose*
- Physical (mobility, chronic illness)
- Vision/Hearing
- Learning
- Psychological (Anxiety, ADHD, Depression, etc)
- Other
*If you prefer not to disclose your disability to TRIO, you can register with Disability Services and report your disability only to them.
Disability – Other*
Are you registered with NIACC Disability Services?*
- Yes
- No
- Not Yet
- Not Sure
Educational Information and Goals
Will you be a full-time student?*
(at least 12 credit hours per term)
- Yes
- No
Do you already have an Associate’s (2 year) or Bachelor’s (4 year) Degree?*
- Yes
- No
Will you graduate from NIACC within 3 years?*
- Yes
- No
Do you plan to transfer to a 4-year institution after earning your Associate’s (2 year) Degree?*
- Yes
- No
Did you require any special accommodations in high school?*
(i.e. IEP or 504)
- Yes
- No
Does parent/guardian 1 have a Bachelor’s Degree (4 year) or higher?*
- Yes
- No
Does parent/guardian 2 have a Bachelor’s Degree (4 year) or higher?*
Please mark N/A if your primary custody remained with 1 parent or guardian
- Yes
- No
- N/A
Have you participated in a TRIO program previously?*
- Yes
- No
Have you submitted the FAFSA?*
- Yes
- No
What is your program of study at NIACC?*
If you plan to transfer, what school are you leaning towards?
What is this highest degree you want to earn?*
- Diploma/Certificate
- Associate’s Degree
- Bachelor’s Degree
- Master’s or Ph.D
About You
What is your main reason for attending NIACC?*
What do you believe will be your biggest academic struggle?*
What factors outside of school could negatively affect your performance? (i.e. Finances, Relationships, Work, Personal Factors/Habits)*
How many minutes is your commute? (avg. one-way)*
- I live on campus
- 10 minutes or less
- 11-20 minutes
- 21-30 minutes
- More than 30 minutes
Hidden
How many hours do you plan to work per week while attending college? (avg.)
- 0 – I don’t plan to work
- 1-10 hours per week
- 11-20 hours per week
- 21-30 hours per week
- 31-40 hours per week
- Over 40 hours per week
What are your current study habits? Is this an area of concern and why?*
Do you anticipate finances will be a source of concern?*
- Yes
- No
- Maybe
How do you plan to pay for costs not covered by financial aid? (i.e. tuition, fees, books, supplies, living expenses)*
What is your career goal?*
Enter Initials*

I grant the NIACC Financial Aid Office permission to provide Federal Tax Information to Student Support Service representatives for TRIO program eligibility.
NIACC does not discriminate in employment or education. See https://www.niacc.edu/about/non-discrimination-statement/ for additional information.
Date*
MM slash DD slash YYYY

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