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TRIO, STUDENT SUPPORT SERVICES\nPROGRAM APPLICATION\nOffice: 513-745-3758\nFax: 513-745-3747\nCOHORT YEAR 2026-2027\nDate:\nFirst Name: ________________ Middle Initial: ____ Last Name: __________________  Birth Date: _____/____/_____\nSocial Security No: __________ - ______ - ___________     Xavier ID#: _____________________________________\nCollege Address: __________________________________ Permanent Address: _______________________________\nCity: ________________ State: _______ Zip: _________     City: ________________ State: _______ Zip: ___________\nLocal Phone: (_______) ___________________________    Permanent Phone: (_______) ________________________\nCellular Phone: (_______) _________________________    Xavier E-mail Address: _____________________________\nCheck ALL that apply:\n_____ Male \t_____ Female\t _____ Single\t_____ Married\t\t_____ U.S. Citizen _____ Permanent Resident\n_____\tAmerican Indian or Alaskan Native\t\t_____\tAsian\t\t _____\tBlack or African American\n_____\tHispanic or Latino\t\t\t_____\tWhite \t\t _____   Native Hawaiian or Pacific Islander\n_____   Adult Weekend/Evening Degree\nCheck the highest level of education COMPLETED by your parent(s)/legal guardian(s):\nGrade\t\tHigh\t\tAssociate’s\tBachelor’s\tBeyond\nSchool\t\tSchool\t\tDegree\t\tDegree\t\tBachelor’s\nMother/Guardia\tn\t_____\t\t_____\t\t_____\t\t_____\t\t_____\nFather/Guardian\t_____\t\t_____\t\t_____\t\t_____\t\t_____\nIf unknown, please explain: __________________________________________________________________________\nDo you have a documented disability?  ____ Yes   ____ No\nIf yes, please identify:_______________________________________________________________________________\nIf yes, have you registered your documented disability with Disability Services?  ____ Yes   ____ No\nPlease contact Accessibility and Disability Resources at (513) 745-3280.\nHave you ever participated in any other TRiO programs?  Yes ____   No ____   If yes, which program? Check below:\n____ Talent Search   ____ Upward Bound   ____ Educational Opportunity Ctr.   ____ Student Support Services\nRequired Documentation: To be turned in with application.\n_____ Copy of 2025 family (guardians, parents, or others) tax information (First two pages of 1040, 1040A, 1040EZ)/financial eligibility.\nI certify that the information on this application is accurate to the best of my knowledge.\nStudent Signature: ___________________________________________________________Date:_________________","cbCaipqOnM1CvkOi","https://ap.wps.com/l/cbCaipqOnM1CvkOi","doc",77824,"English","# Program Application\n## Applicant Information\n## Demographics and Eligibility\n## Education and Disability Information\n## Prior TRiO Participation\n## Required Documentation and Certification","[{\"question\":\"What information does the application request from the student?\",\"answer\":\"The form collects student first, middle initial, and last name; birth date; Social Security number; Xavier ID; college and permanent addresses; and contact phones and Xavier email address.\"},{\"question\":\"How does the form handle disability and Disability Services registration?\",\"answer\":\"It asks whether the student has a documented disability and, if yes, whether the disability was registered with Disability Services, with contact instructions for Accessibility and Disability Resources.\"},{\"question\":\"What documentation is required to submit with the application?\",\"answer\":\"Required documentation includes a copy of 2025 family (guardians, parents, or others) tax information, specifically the first two pages of IRS Form 1040, 1040A, or 1040EZ/financial eligibility.\"}]","PROGRAM APPLICATION - Cohort Year 2026-2027 - Student Program Application Form | DOC",1790655409]