California Polytechnic State University-SLO-SSS-2025 Application Form 2 Language * English (US) * Español * California Polytechnic State University-SLO-SSS * * * Si desea ver el formulario en español, cambie el idioma en la esquina superior derecha. * * Personal Information   * First and last name * First Name Last Name * Nickname or preferred name * Preferred Pronouns * Cal Poly email address * [email protected] * Cal Poly EMPL/Student ID Number * * Phone number * (999)999-9999 * I am a * First-year college student- I have completed high school Transfer student from a previous college institution Continuing Cal Poly student * Eligibility   * The following information is used to determine eligibility for the TRIO Achievers Program. All information will be maintained in a confidential manner consistent with the Federal Family Education Rights and Privacy Act of 1974. Citizenship definitions can be found here: https://studentaid.gov/understand-aid/eligibility/requirements/non-us-citizens * Are you a U.S. citizens, U.S. nationals, or permanent residents (or other noncitizens who qualify for FAFSA, such as select refugee, asylum, or T-visas). * Yes No * If you selected no, are you an eligible noncitizen who qualifies for Federal Financial Aid (FAFSA)? * Yes No Not Applicable * With whom did you most regularly live and receive support from prior to the age of 18? * * Did either of your natural or adoptive parents complete a FOUR-YEAR college degree? * Yes No * Parent/Legal Guardian 1 Education * No high school Some high school High school/GED Some college 2 year college degree (AA) 4 year college degree (Bachelor’s degree) Postgraduate education Not applicable * Parent/Legal Guardian 2 Education * No high school Some high school High school/GED Some college 2 year college degree (AA) 4 year college degree (Bachelor’s degree) Postgraduate education Not applicable * Do you have a documented disability? (e.g. physical, visual, hearing, learning, or cognitive?) * Yes No * Have you registered with the Cal Poly Disability Resource Center (DRC)? Yes No * Income Verification   * Federal Regulations require the TRIO/SSS Program to obtain household and income information to determine eligibility for each student applying to participate. * Please check yes or no * Rows Yes No As of today, are you married? (Answer “No” if you are separated but not divorced.) At the beginning of the 2025–26 school year, will you be working on a master’s or doctorate program (such as an M.A., MBA, M.D., J.D., Ph.D., Ed.D., graduate certificate, etc.)? Are you currently serving on active duty in the U.S. armed forces for purposes other than training? (If you are a National Guard or Reserves enlistee, are you on active duty for other than state or training purposes?) Are you a veteran of the U.S. armed forces?* Do you have children or other people (excluding your spouse) who live with you and who receive more than half of their support from you now and between July 1, 2025, and June 30, 2026? At any time since you turned age 13, were you an orphan (no living biological or adoptive parent)? At any time since you turned age 13, were you a ward of the court? At any time since you turned age 13, were you in foster care? Are you or were you a legally emancipated minor, as determined by a court in your state of residence? Are you or were you in a legal guardianship with someone other than your parent or stepparent, as determined by a court in your state of residence? At any time on or after July 1, 2024, were you unaccompanied and either (1) homeless or (2) self-supporting and at risk of being homeless?** * How do I know if I am an independent or dependent student? https://studentaid.gov/apply-for-aid/fafsa/filling-out/dependency ** Not living with parents or not being claimed by them on tax forms does not make you an independent student for purposes of applying for federal student aid.** * For financial purposes, are you considered a dependent or independent student * Dependent Independent * If you are considered an INDEPENDENT student for financial aid reasons, you must provide YOUR information and taxable income below. If you are considered a DEPENDENT student for financial aid reasons, you must provide the information and taxable income of your natural or adoptive parents below. If you or your parents did not complete an income tax form, record the total of untaxed income for the household during the previous yea * Number in your household (including yourself) * 1 2 3 4 5 6 7 8 Other * Please indicate total family annual TAXABLE INCOME from 2025: Taxable Income is the total AFTER your deductions are taken. This can be found in IRS form 1040 - line 15 or 1040-SR – line 11b. * * EDUCATIONAL AND ADDITIONAL INFORMAITON   * If applicable, what is your college GPA * What areas best describe your academic and/or support need(s)? * Low high school grades Low admission test scores (ACT/SAT) Predictive indicator (commuting student, single parent, working full-time, without support system, personal issues affecting academics) Diagnostic tests (testing for learning disability or study skills inventory) Low college grades Received a GED Failing grades Out of school for 5+ years Limited English proficiency Lack of educational and/or career goals Lack of academic preparedness Need for academic support to raise grades Other * What programs are you currently participating in at Cal Poly? * EOP Cal Poly Scholars Both Neither * What Cal Poly campus are you primarily enrolled in? * Allan Hancock College (Bachelor Pathways Program) Cuesta College (Bachelor Pathways Program) San Luis Obispo (Main Campus) Solano (Maritime Campus) * Academic Need   * What is your major/minor(s) * * What are your career/professional goals * * How can TRIO assist you in completing your degree? Select all areas you feel will assist you in your success. * Graduate school exploration Career exploration Academic and personal goal setting Time/management/organization * Please check all of the services that may interest and/or benefit you * Academic advising Financial Aid information Career counseling Peer mentoring Other * How did you hear about TRIO Achievers? * Advisor Instructor Website TRIO Achievers Staff Member Cal Poly Staff Member Counselor Fellow student Other * Personal Statement and Signature   * In less than 500 words, include any information you feel will assist us in learning as much about you, your interest, and your need for the services provided by TRIO Achievers. Your autobiography may include: your birthplace, where you grew up, why you want to participate in TRIO Achievers, how TRIO Achievers can assist you, which services you can benefit from, academic achievements, academic struggles and your goals in life. * * EQUAL OPPORTUNITY Thank you for your interest in the TRIO Achievers/Student Support Services at Cal Poly. All applicants will be considered without regard to race, color, religion, national origin, sexual orientation, marital status or disability. DECLARATION I understand that as a participant in TRIO Achievers (also known as Student Support Services), any or all of the academic support services of Student Affairs will be available to me. I understand that all data collected will be kept confidential. By typing and signing my full legal name in the box and clicking submit, I grant permission to TRIO Achievers to track all of my academic progress at Cal Poly and at any other academic institution. I authorize the release of my student academic, personal and financial aid records for the TRIO Achievers program to use and for reporting purposes to the U.S. Department of Education. In addition, I hereby give my permission for my photograph, work and/or statements to be used by TRIO Achievers for promotional, publicity or instructional purposes. All information provided is accurate to the best of my knowledge. DISCLOSURE STATEMENT The TRIO/SSS Program at Cal Poly, San Luis Obispo is funded through a Federal TRIO Grant from the U.S. Department of Education. Annual Funding (2026-2027) is $358,191.00 (100%) total funds. * Full legal name of applicant * First Name Last Name * Digital signature of applicant * * *Note if you are dependent on your parent’s income, they must sign this application before submission to confirm the tax information listed is accurate. * Full legal name of parent/guardian (if you are a dependent student First Name Last Name * Digital signature of parent/guardian (if you are a dependent student * Date *  - Month  - Day Year 2 digit month, 2 digit day, 4 digit year Date * Back Next Save * Please verify that you are human * * Save Submit * Should be Empty: