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Applicants Name *
Applicants Name
Current Address *
Current Address
Home Phone *
Home Phone
Cell Phone
Cell Phone
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We require the following information for the purposes of helping our staff use the most respectful language when addressing you, understanding our population better, and fulfilling our grant reporting requirements. The options for some of these questions have been provided by our funders. Please help us to serve you better by selecting the best answers to these questions. Thank You.
Race *
Check all that apply
Veteran *
Marital Status *
Citizenship *
Identify when you first enrolled at Montana Tech? (Identify Year)
What is your class standing at Montana Tech? (Select One)
Have you declared a Science, Technology, Engineering, or Mathematics (STEM) as your major?
If you have declared a STEM Degree, what is your major?
Did you apply for and receive Financial Aid this year?
TRIO SSS Participation *
What TRIO SSS activities might you participate in? (Check all that apply)
TRIO SSS Utilization *
Reasons for utilizing TRIO SSS (Check all that apply)
Other reasons for utilizing TRIO SSS
Of the parent(s) or guardian(s) with whom you regularly lived before you reached your 18th birthday, did any complete or already have a four-year degree?
Do you have a documented disability? (Physical/Learning/Emotional/Mental)
Agreement to Program Participation *
I certify that the information on this application is accurate and complete to the best of my knowledge. I hereby authorize the Student Support Services program to obtain any information from my educational records (e.g., transcripts, entrance test scores, grades, instructor contacts, etc.) and to perform staffing activities that may be pertinent to my participation in the program. I also agree that, if I am selected to participate in the TRIO SSS program, I will work with my staff adviser to develop and implement an individual Education Assessment Plan.