TRIO Student Support Services Application

Thank you for your interest in CSULB TRIO Student Support Services (TRIO-SSS)! Please complete this application in its entirety. You will not be able to save and restart this application.

Please preview the application requirements, gather all information needed to complete and submit this application.

Please view the TRIO Student Support Services website for eligibility requirements.

Note: Students are not eligible for TRIO-SSS if enrolled with CSULB as an International student, or in a Graduate program, or are admitted into the EOP program, or are enrolled in the College of Professional and Continuing Education Program (CPaCE).

If you need assistance or an alternative application, please contact us at 562-985-2185 or sssp@csulb.edu. We are here to help!

General Information

Student Information:

First Name: *

Middle Initial

Last Name: *

Date of Birth (mm/dd/yyyy): *

CSULB ID *

CSULB Email: *

Phone Number: *

Gender *

Demographic Information:

Complete each category.

Hispanic Origin *

American Indian or Alaskan Native *

Asian *

Black or African American *

White *

Hawaiian or other Native Pacific Islander *

Eligibility Information

Citizenship or Residency Information *

Disability Information *

First Generation Information *

Who did you regularly reside with and receive support from until you were 18 years old?

Dependency Information

I will be at least 24 years old starting this academic year? *

As of today, are you married? (answer “Yes” if you are separated but not divorced.) *

Do you have or will you have dependents who receive more than half of their support from you between July 1st and June 30th of this academic year? *

Are you currently serving on active duty or a Veteran in the U.S. armed forces? *

At any time since you turned age 13, were both of your parents deceased, were you in foster care, or were you a ward or dependent of the court? *

Are you an emancipated minor or are you in a legal guardianship as determined by a court? *

Are you an unaccompanied youth who is homeless or self-supporting and at risk of being homeless? *

Household Income and Size

Did you answer NO to all of the Dependency Information questions above?
1. Complete the following with your PARENT/GUARDIAN tax filing information.
2. A parent or legal guardian’s signature is required.
  - Incomplete applications will be delayed until all required signatures are provided.

Did you answer YES to any of the Dependency Information questions above?
1. Complete the following using YOUR tax filing information.

Household Size (Including Yourself) *

Did You or Your Parent/Guardian file a Federal Tax Return? *

Provide the STATE the taxes were filed in. (use NA if taxes not filed) *

Taxable Income Amount ($) *

Parent/Legal Guardian Signature:

I am the parent/legal guardian of the applicant. The information provided and signature is valid as if signed in writing and confirms that I am the parent or legal guardian of the applicant. I acknowledge and indicate an agreement and understanding of all information and statements provided throughout this application are true and accurate to the best of the applicant and my knowledge.

Parent Signature

Signature Type: Simple Start Over

Reset Signature Pad

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Signature: (Type in your full name)

I agree to the terms included.

Academic Needs Assessment

Select all areas that interest you or may benefit you

Academic Advising Assistance:

General Advising

Major Selection

Degree Planning

Course Selection

Study Abroad

Raising College Grades

CSULB Policies and Procedures

Learning Skills & Tutoring Resource Assistance:

Tutoring Resources and Referrals

Locating and Using Campus Resources

Time Management Strategies

Writing Assistance

Academic Learning Skills

Technology Assistance

Skill Building

Course Work Preparation

Financial & Economic Literacy Education:

Finance & Budget Education

Budgeting Education Costs

Locating Housing Resources

Investing & Money Management

Financial Aid & Scholarship Information Assistance

Finding Scholarships

Finding Financial Aid Programs

Financial Aid Advising

Loans & Grants Advising

FAFSA or CADAA Assistance:

Completing the FAFSA

Completing the CADAA

Graduate School Assistance:

Graduate School Guidance

Researching Graduate Programs

Graduate School Preparation

Graduate School Application

Career Readiness Assistance:

Professional Development

Career Goals Guidance

Employment or Internship Search Strategies & Preparation

Resume/Cover Letter Assistance

Tell us how TRIO-SSS may help you accomplish your academic goals?

Photo Release

I grant permission to California State University, Long Beach/California State University (CSULB/CSU), its employees, agents, and auxiliaries, to take and use visual images, video, and audio recordings of me.

I agree that CSULB/CSU, its employees, agents, and auxiliaries owns the images, video, and audio and all rights related to them.

The images, video, and audio may be used in any manner or media without notifying me, such as university-sponsored Web sites, publications, promotions, broadcasts, advertisements, posters and theater works.

I waive any right to inspect or approve the finished images, video, and audio or any printed or electronic matter that may be used with them.

I release CSULB/CSU and its employees, agents, and auxiliaries including any firm authorized to publish and/or distribute a finished product containing the images, video, and audio, from any claims, damages, or liability which I may ever have in connection with the taking or use of the images, video, and audio or printed material used with the images.

I am at least 18 years of age and competent to sign this release. I have read this release before signing, and understands its contents, and they freely accept the terms.

I understand that if I choose to decline the photo release, I am agreeing to remove myself from any areas which any image producing materials may be taking place. By not removing myself, I am immediately and voluntarily revoking my statement to decline the photo release.

I understand that if I am under 18 years of age my parent/legal guardian has read this release before signing, and understands its contents, and they freely accept the terms.

I understand that if I am under 18 years of age my parent/legal guardian choses to decline the photo release, I/my parent/legal guardian am agreeing that I am responsible for removing myself from any areas which any image producing materials may be taking place. By not removing myself, I/my parent/legal guardian am immediately and voluntarily revoking the statement to decline the photo release.

Affidavit of Truth and Certification of Release of Information

All signatures acknowledge and indicate an agreement and understanding of all information and the statements provided throughout this application are true and accurate to the best of the applicant and signee(s) knowledge.

All signatures indicate authorization to release the applicant's student records to the TRIO-SSS staff for the purposes of; assessing the applicant's need for services, monitoring academic progress, evaluating program effectiveness, fulfilling program-reporting requirements, and advocating on behalf of the applicant with CSULB campus partners.

All signatures acknowledge and understand that meeting minimum eligibility requirements does not a guarantee of acceptance into TRIO-SSS.

All signatures on this document are valid as if signed in writing.

Notice: A parent or legal guardian’s signature is required if the applicant is admitted to CSULB as a dependent student and/or is under 18 years of age.

Student Signature*: Use the signature pad below to sign your application.

*