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Veteran Student Support Services Application
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Veteran Student Support Services Application
Veteran Student Support Services Application
Veteran Student Support Services Application
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First Name
*
First Name
Last Name
*
Last Name
Date of Birth
*
Street Address
*
Street Address
City
City
State
State
Phone Number
*
Phone Number
Email Adress
*
Email Address
Personal Information
Gender
Male
Female
Other
Ethnicity
American Indian or Alaska Native
Asian
Black or African American
Hispanic/Latino
Caucasian/White, non-Latino
Native Hawaiian or Pacific Islander
Other
Mark all that apply
Are you a US citizen?
*
Yes
No
Permanent Resident Alien
*
Yes
No
Do you have a permanent resident alien number?
Permanent Resident Alien Number
Employment Status
*
Employed Full Time
Employed Part Time
Unemployed
Retired
Employer Name
*
PREVIOUS year's taxable income
*
Estimate if necessary
Family Size
*
How many did you claim on your taxes?
Academic Information
Current College Level
Freshman (1-29 hours)
Sophomore (30-59 hours)
Junior (60-89 hours)
Senior (90+ hours)
Major
*
Are you a transfer from a 2-year college?
*
Yes
No
Do you plan to earn a bachelor's degree from WSU?
*
Yes
No
Target Graduation Date
*
When do you plan on graduating?
Are you a full time student?
*
Yes
No
Are you on Academic Probation?
*
Yes
No
Current GPA
*
Has either parent earned a 4-year college degree?
*
Yes, Mother
Yes, Father
Both
Neither
Have you been out of the academic pipeline for more than 5 years?
*
Yes
No
Military Information
What is your current military status?
*
Active Duty Servicemember
Veteran, no longer active duty
Spouse of active duty service member
Spouse of veteran
ROTC
Child dependent of active duty servicemember
Child dependent of veteran
Service Branch
*
Type of discharge (if veteran)
*
Honorable
General/Under-honorable
Dishonorable
Entry-Level separation
Disability Status
*
Disabled
Non-Disabled
Not Applicable
Is your disability military-related?
*
Yes
No
Not Applicable
Are you currently receiving any kind of NON-VA related financial aid (i.e.-FAFSA, loans, active-duty TA)?
*
Yes (please specify below)
No
Name of Educational Benefit Receiving
Are you currently receiving any kind of VA educational benefits?
*
Yes (specify below)
No
Type of VA Educational Benefit Received
What is your reason for entering Veteran Student Support Services?
Are you currently participating in another TRIO Student Support Services Program?
*
Yes (please specify below)
No
Which TRIO Student Support Services Program are you currently participating in?
Student Support Services (SSS)
Disability Support Services (DSS)
STEM Student Support Services
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