Grand View University 

1200 Grandview Ave, Des Moines, IA 50316 

Phone: (515) 263-2931 

https://www.grandview.edu/academics/support/trio

2025-2026 Program Application

Student Support Services (SSS) is a federally funded TRIO program designed to increase the retention, persistence and graduation rates of students from populations historically underserved and underrepresented in higher education. Students receive comprehensive, individualized support to empower and encourage our students to identify, develop, and pursue their educational and personal goals. We help our students develop the knowledge, habits, and skills necessary to be successful.

Instructions: 

Please complete the application in full in one sitting as it will not save your progress and it does time out after about 20 minutes. We ask that you answer each question, but please note that those marked with an * are required for submission.

Materials Needed to Complete the Application: 

  • Parent(s) 2024 Taxable Income (for Dependent Students)
  • Student 2024 Taxable Income (for Independent Students) 
  • For students with disabilities, it may be helpful to have documentation saved electronically and ready to upload. Otherwise you may submit by e-mail or mail. 

Part 1: Personal Information
Last Name *
First Name *
Middle Name
Permanent Address *
Permanent City *
Permanent State *
Permanent Zip *
Cell Phone Number *
Date of Birth *
Sex:
Federal regulations require that TRIO participants be either a US Citizen or Permanent Resident. Please select the appropriate status. *
For Permanent Resident Only A#:
Student ID Number
Campus Mailbox
Email Address
Class Level

Part 2: Race/Ethnicity 

 
American Indian or Alaskan Native
Asian
Black or African American
Hawaiian or other Native to Pacific Island
Hispanic or Latino
White

Part 3: Educational Information
High School Name
City & State of High School
High School Graduation Date
Are you a transfer student?
If yes, please list your: Previous College, Date of Last Attendance, Degrees Earned
Approximate Number of Prior Credits Earned
Enrollment Status at Grand View *
Intended or Declared Major (if undecided, write "Undecided") *
Intended or Declared Minor (if undecided, write "Undecided") *
How were you referred to TRIO Student Support Services?
Have you ever participated in a TRIO or other college access program before?
If yes, which program?
If yes, where?

Part 4: Needs Assessment

Utilizing the following scale, indicate the response that best reflects your skills/confidence as a student:

1 = very low; 2 = low 3 = satisfactory 4 = high 5 = very high

 
Self-discipline *
Confidence *
English Language Proficiency *
Motivation *
Comfortable in Social Setting *
Time Management *
Study Habits *
Knowledge of college academic expectations *
Sense of Financial Security *
Academic Preparedness *
What do you see as the biggest obstacle or challenge you (will) face at Grand View University? * *
Briefly explain why you should be accepted to the TRIO SSS Program and how you plan to use the services to help you succeed. *

Program Eligibility: In order to participate in TRIO-SSS, students must be either a US Citizen or Permanent Resident and meet at least one of three criteria

  • Be a first-generation student
  • Have a documented disability
  • Meet TRIO income guidelines (updated each year by the US Department of Education)

Completing Parts 5-7 will allow TRIO-SSS staff to determine the student eligibility. All information will be maintained confidentially in the participant's file.

Part 5: First-Generation Verification 

The term "first-generation college student" refers to a college student whose parent(s) did not complete a bachelor's degree. 

 
Highest educational level or grade your parent(s) completed. Check one for each parent.
Parent 1: *
Parent 2: *

Part 6: Disabilities Verification  
Do you have a documented physical and/or learning disability? *
If yes, do you have appropriate documentation on file with the Grand View University accessibility services office? *Please note, if you select "Yes," the SSS Director will confirm with the Director of Accessibility for the purpose of verifying eligibility.

Documentation must be on file in order for you to qualify for SSS as a student with a disability.

Upload documentation below or send by e-mail/mail:

Email: sneve@grandview.edu

USPS Mail: 1200 Grandview, Ave Des Moines, IA 50316
If you have your documentation available, you may upload it here.

Part 7: Income Eligibility Verification
On the FAFSA, are you a Dependent or Independent student? * *

In accordance with 20 U.S. Code 1070a-11 - Program authority; authorization of appropriations, appropriate documentation of status as a low-income, dependent individual can be provided in one of the following forms: 

  • a signed 2024 United States or Puerto Rico income tax return
  • a signed statement verifying 2024 Taxable Income (see sections A and B following) 
  • verification from another governmental sources

Statement of Income: Please Complete ONLY the section pertaining to you

A. Dependent Student 

OR 

B. Independent Student 

A. Dependent Student (to be completed by a parent(s) listed on the FAFSA):

Please answers questions 1, 2,  AND 3 below: 

Enter NA if you are an Independent Student. 
1. 2024 parents' taxable income from taxes prepared (use line 15 on IRS from 1040: $ *
2. Total number of individuals in household (yourself, even if you don't live with your parents; your parents; your parents' other children, and other people if they now live with your parents and your parents provide more than half of their support and will continue to provide more than half of their support between July 1, 2025 and June 30, 2026): * *
3. I acknowledge that the information listed here is true and correct to the best of my knowledge.
Student Full Name *
Parent Signature (Required for Dependent Students)
Please select a signature verification type.

B. Independent Student (students whose FAFSA did not require parent information)

Please answer questions 1, 2, and 3 below:

Enter NA if you are a Dependent student and completed section A.
1. 2024 STUDENT'S taxable income from taxes prepared:(use line 15 on IRS from 1040: $ *
2. Total number of individuals in household. (Include yourself and other people if they now live with you, and you provide more than half of their support and will continue to provide more than half of their support between July 1, 2025 and June 30, 2026) *
3. I certify that the information listed here is true and correct to the best of my knowledge.
Please select a signature verification type.

Part 11: Release of Information

I acknowledge that by applying for this program, I authorize TRIO/Student Support Services to confer with Grand View University faculty and staff to gather other necessary information to determine eligibility, provide program services, and to make reports to the U.S. Department of Education in accordance with grant funding regulations.  I understand that the information will be kept confidential and will be used for the following specified purposes:  a) student demographic data and recordkeeping, b) program evaluation, c) needs assessment, d) federal reporting, and e) other administrative purposes.

I am granting permission for the Student Support Services staff at Grand View University to have access to my academic and financial aid records. Additionally, I am granting permission to the Grand View University Accessibility Services office (Accessibility Services may confirm receipt of disability documentation to determine my eligibility for the TRIO/SSS program.)

I am aware that personal information provided to the TRIO/Student Support Services program will be protected under the Federal Education Rights & Privacy Act (FERPA) of 1974.

I understand that the completion of this application does not guarantee acceptance to the Grand View University TRIO/Student Support Services program.

Part 10: Affidavit of Truth Statement

I certify that the information provided on this form is true and correct to the best of my knowledge. 

 
Student Signature *
Please select a signature verification type.
Parent/Guardian Signature (Required for dependent students)
Please select a signature verification type.