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TRiO Program Application

Sunday, October 17, 2021

TRIO Student Support Services logo

TRiO Student Support Services
University of Arkansas - Pulaski Technical College
3000 West Scenic Drive
A Building, Room 127
North Little Rock, AR 72118
(501) 812-2720

The following information is requested to determine your eligibility to participate in the TRiO Student Support Services Program at UA - Pulaski Technical College, a federally funded program designed to help you succeed in college. All information is confidential. TRiO staff will contact you with more information about the program if you are eligible to participate in it.

Sex:
US Citizen:
Are you Hispanic or Latino Decent:
Race: (Please check all that apply)
Do you have a documented disability?
Did your Mother or Father graduate from college with a Bachelor’s Degree? (Select the parent)
Referral?

My electronic signature below gives full permission to the TRiO Student Support Services Program at UA - Pulaski Technical College to review my financial and academic records including, but not limited to, my FAFSA application, test scores and transcripts. This information will be used to determine my eligibility to participate in the program. The program may also access pertinent records related to my attendance/graduation at another university as may be required for federal reporting purposes.


I understand that typing my full name in this box constitutes a legal signature confirming that I acknowledge and agree to the understandings above.