TRIO SSS Current Creighton Student Application

Applicant Information

NetID

First Name

Middle Name

Last Name

Birthdate

Are you a United States citizen or permanent resident?

Yes

No

Gender

Female

Male

Email Address

Phone

I am applying for academic semester:

Fall

Spring

For the year:

What is your student status?

What is your current cumulative GPA?

Permanent Mailing Address

Mailing Address

Country

Street

City

Region

Postal Code

Parent of Legal Guardian Information

Please mark the highest level of education completed by your parents or guardians

Guardian #1

Guardian #2

Language other than English spoken by parents

Financial Information

What is your household's total taxable income?

How many people are in your household (including you)?

Federal Governments Income Levels

TRIO Pipeline

Have you participated in any of the following programs?

Upward Bound?

Talent Search?

Educational Opportunity Center?

Student Support Services?

College Possible

Gear Up

Eligibility

Disability Status

Have you previously received accommodations (ex: IEP, 504 plan)?

Have you registered with Creighton's Office of Student Accessibility Services?

I give permission to TRIO SSS to reach out to Student Accessibility Services (SAS) to confirm my disability status. I understand that it is my responsibility to provide SAS with the necessary information to confirm disability status.

Academic Need

All students enrolled in the Student Support Services Program must have a need for services. Please check all items that apply. You MUST check at least one or more options to be eligible for this program.

Please tell us about your areas of academic need:

Please specify your referral's name:

Short Essay Responses

Please answer the questions listed below. Limit your response to no less than 150 and no more that 250 words for each question.

How can SSS support your educational journey?

Additional questions, comments, statements, etc.:

Please upload a photo of yourself to include in your application file. This photo will also be used for our program directory if accepted to the program:

Please provided a signature here to confirm all statements made in this application are true to
the best of your knowledge (if under 19 parent's/guardian signature is required.)

Click to Sign...