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TRIO Achievement Program
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TRIO Application Form
TRIO Application Form
Priority deadline is June 30
*
= required field
PART I: APPLICANT INFORMATION
First Name
*
Middle Initial
Last Name
*
Preferred Name
Luther ID
*
Date of Birth
*
Home Address (Street or P.O. Box)
*
Home City, State, Zip
*
Home Phone
Cell Phone Number
Email (other than Luther email)
Luther email
Emergency Contact Name
*
Relationship of Contact to You
*
Emergency Contact Phone Number
*
Gender Identity
*
Male
Female
Non-Binary
Citizenship
*
U.S. Citizen
Permanent Resident
Non U.S. Citizen eligible for federal student aid
Race/Ethnicity: (check all that apply)
*
American Indian or Alaska Native
Black or African-American
Native Hawaiian or Pacific Islander
Asian
Hispanic or Latino
White
Do you have a documented* disability (physical disability, learning disability, etc.)?
*
Yes
No
*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?
Yes
No
If you were referred to TRIO, please indicate the individual’s name and title:
PART II. ACADEMIC INFORMATION
Student Status
*
New
Transfer
Returning
Expected Year of College Graduation
2022
2023
2024
2025
Have you participated in another TRIO Program or similar support program?
*
Yes
No
If yes, please specify
Upward Bound
Talent Search
Student Support Services
Gear Up
Other
Year of High School Graduation
*
Were you home-schooled?
*
Yes
No
Did you earn a GED?
*
Yes
No
Did you take college courses while in high school?
*
Yes
No
If yes, college credits earned:
PART III. FAMILY INFORMATION
I currently reside with
*
--
Mother
Father
Mother and Father
I am independent
Guardian (see below)
If you responded guardian above, please specify relationship to you
Mother's educational background: (check only the highest level completed)
*
Unknown
Did not complete high school
High School
Some college, no degree
Associate' Degree
Bachelor's Degree
Higher than Bachelor's
Father's educational background: (check only the highest level completed)
*
Unknown
Did not complete high school
High School
Some college, no degree
Associate's Degree
Bachelor's Degree
Higher than Bachelor's
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!
Indicate "Independent" in the box ONLY IF you are considered to be an independent student for financial aid purposes (then enter "0" in the remainder of the financial section).
Year printed on tax return (enter N/A ONLY IF your family did not file and enter "0" in the remainder of the financial section).
*
Family Size (Number in your household, including yourself)
*
Adjusted Gross Income
*
Taxable income
*
NOTE: Taxable Income is almost always LOWER than Adjusted Gross Income.
Does your financial aid award include the Federal Pell Grant?
*
Yes
No
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
*
Mathematics
Writing
Reading (speed and/or comprehension)
Science
Non-native languages
Music
General study skills
Other areas
*
Organizational skills
Social skills and connections
Time management
Financial challenges
Major/career decision-making
Learning obstacles or disabilities
Physical or mental health challenges
Family obligations or expectations
Other factors impacting college
Your proposed major
Career interests
I plan to be involved in
athletics
music
other extra-curricular and/or co-curricular activities
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
*
FOUNDATIONS FOR LEARNING AND DEVELOPMENT (GS 100): Foundations for Learning and Development, a course available to first-year TRIO participants, sets the stage for the Luther experience and helps you start off strong.
Free tutoring to ensure you are understanding the material and getting the most out of your education.
Help with career exploration and finding your purpose!
Workshops that help you transition and thrive.
Advice and assistance in course selection.
Checking out helpful educational tools (i.e. laptop, Smart Pen, etc.) through the technology lending program
Help in setting and reaching academic, financial, career, and personal goals.
Help in strengthening your study strategies, organization, or time management skills.
Understanding and accessing financial assistance to help you pay for college.
Help in cultivating wise money management practices that will serve you now and throughout your life.
Assistance with graduate school or professional school exploration and admission.
Checking out textbooks through the TRIO textbook lending library.
Peer mentoring from other TRIO particiants.
Networking/social activities.
Free supplies and copies.
Access to TRIO resource library for additional guidance (everything from finances to strengths to vocation).
Other (please indicate in your answer in the next question, below)
Can you think of anything that could keep you from completing your degree, such as family, grades, social life, money, motivation, career decision, etc.? Please describe:
PART VII. AUTHORIZATION AND AFFIRMATION
Please read and check each box to indicate you understand these authorizations.
*
I hereby authorize the Luther College TRIO Achievement Program to obtain academic, financial, and other information pertinent to my admission to and participation in the TRIO Achievement Program.
I understand that a copy of my application form will be kept on file at the TRIO Achievement Program office and that the resulting information received from admission and financial aid officers will be kept confidential in compliance with the Family Rights and Privacy Act.
I affirm to the best of my knowledge that the information I have provided is true.
I give permission for TRIO to use photos, etc. of me upon acceptance into the TRIO Achievement Program.
This application must be signed before submitting.
*
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