STUDENT SUPPORT SERVICES OF DEPAUL UNIVERSITY

APPLICATION FORM

First Name:		Middle Name:		Last Name:
Student Identification Number: (This is a seven digit number starting with a "0".)

Preferred Mailing Address

Alternate Mailing Address (if any)

Preferred Phone Number with area code *	Alternate Phone Number with area code (if any)*

* Valid Phone Number Format: 773.555.1234

Preferred Email Address
Email Address:
How often do you use this account?
Is this account HTML enabled?	Yes No I don't know

Other Email Address (if any)
Email Address:
How often do you use this account?
Is this account HTML enabled?	Yes No I don't know

Eligibility

Employment

Are you a U.S. citizen or U.S. national?	Yes No
None of your custodial parent(s)/guardian(s) holds a bachelor's degree.	True False
Are you eligible for US Federal Student Financial Assistance?	Yes No

How did you hear about us?

Please select from the following:		If other, please specify:

Previous Trio Program Participation (if any)**
Name of Trio Program:
School or Institution:
When did you become a member of this program?
How long were you a member of this program?
**Note: If you have been a member of more than one Trio program in the past, please indicate your most current membership here.

If you encounter any problem with this site, please email Yared Tamene at ytamene@depaul.edu