TRIO Application Form

Priority deadline is June 30

* = required field

PART I: APPLICANT INFORMATION
Gender Identity*
Citizenship*
Race/Ethnicity: (check all that apply)*
Do you have a documented* disability (physical disability, learning disability, etc.)?*
*Documentation could include information from 504 Plan, IEP, medical doctor, psychiatrist, therapist, etc.
If yes, have you been in contact with Luther College Disability Services?
PART II. ACADEMIC INFORMATION
Student Status*
Expected Year of College Graduation
Have you participated in another TRIO Program or similar support program?*
If yes, please specify
Were you home-schooled?*
Did you earn a GED?*
Did you take college courses while in high school?*
PART III. FAMILY INFORMATION
Mother's educational background: (check only the highest level completed)*
Father's educational background: (check only the highest level completed)*
PART IV: INCOME INFORMATION - Required to Determine Financial Eligibility - DO NOT LEAVE BLANK!
The information in this section, required of all applicants, is used to determine eligibility for participation in the TRIO Achievement Program and will be treated confidentially. Last year’s Income Tax Return must be submitted to the Luther College Financial Aid Office.
If you have any questions about this section, please contact the TRIO office!
NOTE: Taxable Income is almost always LOWER than Adjusted Gross Income.
Does your financial aid award include the Federal Pell Grant?*
PART V: NEEDS LIST
The TRIO Achievement Program wants to best serve your needs. Please take a moment to indicate those areas you may need help with as you make the transition from high school to college. Check all that apply.
Academic skills*
Other areas*
I plan to be involved in
PART VI. SERVICES AND ACTIVITIES
Although we would like to offer services to everyone who is eligible, the TRIO Achievement Program is only funded to serve 160 Luther students. Naturally, we want to provide services to students who will take advantage of them and participate for all four years. Please indicate the services and activities in which you wish to participate. Check all that apply.
Please indicate the services and activities in which you wish to participate. Check all that apply*
PART VII. AUTHORIZATION AND AFFIRMATION
Please read and check each box to indicate you understand these authorizations.*
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