SSS Online Interest Intake Form

Program Eligibility: How would you qualify? (Select all that apply. Preference is given to students who meet two of the three eligibility requirements) *

Low Income: Your or your family's taxable income meets SSS federal guidelines, or you are receiving federal financial aid (Pell Grant).

First Generation: Neither of your parents/legal guardians received a four-year degree (bachelors) before you were 18 years old.

Disabled: You have a documented disability (physical, psychological, or learning) with documentation on file at the Utah Tech Disability Resource Center.

Have you ever participated in a TRiO program? *

Educational Talent Search

Upward Bound

No

Personal Information

First Name *

Last Name *

Dixie ID *

see your admissions letter

Email *

Phone Number *

Home Mailing Address *

Home Mailing Address

City

State/Province

Zip/Postal

In 100 words or fewer describe how being a part of Student Support Services would benefit you.

Personal Information