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TRiO Student Support Services Student Application

Please use this form to submit your application to TRiO. A printable form is also available here.

Please enter your first name. Please enter your last name. Please enter an ID. Invalid ID number. Invalid ID number. Please enter a number. Please use XXXXXXXXXX. Please enter your birthdate Please enter an email. Invalid email. Please enter an email. The emails don't match.




I am interested in participating in the TRiO SSS program, including all of its special services. I understand and agree:

  1. to complete mandatory Financial Literacy modules.
  2. to use TRiO SSS services, including academic counseling, tutoring and computer use.
  3. that the Academic Counselor will track my progress and notify me with recommendations which will assist my coursework each semester.
  4. to allow my picture to be taken and used for promotional purposes for the SSS program.
  5. that TRiO staff members may confer with SUNY Canton faculty and staff as necessary, to provide me with support and services.
  6. that I may be de-selected from TRiO at any time.
  7. that the information will be kept confidential and will be used for the following specified purposes:
    1. student demographic data and recordkeeping
    2. program evaluation
    3. needs assessment SUNY Canton OR TRiO Student Support Services 34 Cornell Dr. – CC233 Canton, NY 13617 315-386-7684
    4. federal reporting
    5. other administrative purposes

TRiO Student Support Services
SUNY Canton
34 Cornell Drive
Canton, NY 13617

Campus Center 233