Participant Update Form

Date:

Your SSS Academic Advisor:*

Karen Wright

Chelsea Martinez

Dr. Linda F. Rhone

Prajakta Isanpure

Indu Priya Chavva

Last Name:*

First Name:*

myWSU ID:*

Current Address:*

City:*

State:*

Zip:*

Email Address:*

Primary Phone Number:*

Secondary Phone Number:

Emergency Contact:

Contact Person:

Phone:

Current Semester Class Schedule:

Class 1:

Class 2:

Class 3:

Class 4:

Class 5:

Class 6:

College Classification:

Major:*

Your Target Graduation Date:

Are you receiving financial aid?*

Yes

No

Are you on probation?*

Yes

No

If yes, what type?

Are you currently receiving any services from a TRIO program?*

Yes

No

If yes, what type?

DSS

McNair

Please identify the needs by checking on the boxes below:

Academic Tutoring

One-on-One

Walk-in

Individualized advising:

Academic Advise

Study skills

Goal Setting

Motivation

Career Advise

Resume writing/Cover letter

Interviewing skills

Internships

Personal Advise

Stress management

Time management

Organizational skills

Mentoring Services

Peer mentor

Faculty mentor

Other

Advice and assistance in postsecondary course selection

Assistance with degree planning

Advice on course selection (e.g. gen. ed. or major requirements)

Information on Federal student financial aid programs and benefits

Assistance in completing financial aid applications

Information on resources for loans, grants, and scholarships

Education services to improve economic and financial literacy

Assistance with budgeting, savings, and credit

Student loan repayment plan

Assistance in applying for admission in graduate school

Assistance with information and/or application procedures

Letters of recommendations

Graduate school application fee waiver

McNair Scholar’s Program referral

Other Academic Support Services

Use of the SSS Technology Learning Lab(on-campus computer use & printing)

Laptop/iPad Checkout

Textbook Checkout

By checking the box, I certify that I agree to reaffirm my agreement(s) under the Student Participation Agreement and Lounge Usage Contract.*

I agree.