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If you have already achieved a 2 to 4 year degree you do not qualify for this program.

Enter the information below

If yes, you do not qualify for the program

From the options below, select the one that best decribes your living situation.

Indicate highest level of education completed by your natural (or adoptive) parents with whom that you live have attained. (Do not record the education of any step-parent who has not adopted you or any other guardian)

Enter Disability Status, if any

For example: a divorce, a loss of job, or a death in the family

 (Check all that apply to you.)

If accepted in COPE/Experience VU Student Support Services (SSS), I agree to the following:


  • I will attend the SSS Program’s New Student Orientation
  • I will enroll in and complete the associated University Experience course (SSKL 006).
  • I will be honest and conscientious during my meetings with my SSS Program professional. Additional participation may be required via tutoring, workshops, cultural events, or academic enhancement.
  • I will review my mid-term grades each semester and discuss with my Program professional.
  • I will contact the SSS main office each semester regarding advising for the next semester.
  • I will attend all classes and complete all work in a timely manner. (SSS receives notices when our students do not attend classes, miss assignments, and perform well in classes.)
  • I will contact Program professionals when I am unable to attend scheduled appointments/events.


I understand that I may lose my status as a SSS participant if I do not follow the terms of this agreement.


By applying to the TRIO SSS Program, I understand that the Program staff may obtain records or data pertinent to my eligibility and my participation from other sources. These sources may include, but not necessarily limited to, the VU Student Financial Services, the VU Bursar, the VU Registrar, the VU Office of Diverse Abilities and Accomodations, VU Staff and faculty, the National Student Clearinghouse, and other educational professionals at other institutes of higher education..

I also understand that the SSS Program staff may release information to the grant funding agency of the United States government, as required by the law or the terms of the SSS grant.

Furthermore, the SSS Program professionals have my permission to communicate with VU staff and faculty, family members, community agencies, and/or off-campus professionals on my behalf. I also give my consent for the SSS program to use photos or videos taken of me by SSS staff during SSS sponsored or VU sponsored activities for SSS promotional material.

Finally, I release the Staff of SSS from all legal responsibility or liability that may arise from the actions that I have authorized.

I certify that I have read the terms of this agreement and release and that the information that I have provided on this application is--to the best of my knowledge--true, accurate, and complete.

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