2025-26 SSS Application

Thank you for your interest in our Student Support Services program!  Please complete this application as thoroughly as possible.  You cannot save and restart this application. 

Please review the required information and take some time to make notes and gather the required documents, and then return to submit your application. 

Required information:

  • 2023 Family's taxable income
    •  Line 15  on  tax form 1040
  • Number of people in household
  • Parent's signature
  • Parent(s) or Guardian(s) educational level.
  • Two short answer questions
  • Student's Signature

If your SSS application does not submit:

  • Make sure all required fields are submitted.  The items not submitted will be listed in red after you click the submit button.
  • If you use the signature pad option for your signature, Click the Sign and Submit button.  Type in your name.
  • Check the I agree to the terms included" checkbox
  • The systems times out after 20 minutes, so this may cause you not being able to submit the application.

When the application is successfully submitted, you will receive a message about thanking you for applying with the option to send an email confirmation.

If you have any questions, please call our office at 715-425-3713 or email SSS@uwrf.edu

 

General Information
Falcon ID *
First Name *
Middle Name
Last Name *
Chosen Name

 
Date of Birth *
Are you an US Citizen, Permanent Resident or Resident Alien? *

 

 
Gender *
Pronouns

 
Race, Hispanic *
Race, American Indian or Alaskan Native *
Race, Asian *
Race, Hawaiian or other Native to Pacific Island *
Race, Black or African American *
Race, White *

 
How did you find out about SSS? *
Have you ever been a TRIO participant? *

 TRIO programs include: Upward Bound, Talent Search, Student Support Services, Educational Opportunity Center.
If yes, list program and school.

 

Electronic Contact Information:
Cell Phone Number *
UWRF Email Address *
Alternative Email Address: *

 

Permanent Address
Permanent Address *
Permanent Address 2
Permanent City *
Permanent State *
Permanent Zip *

 

Local Address:  Leave blank if unknown.

If you live off campus, enter your complete address.

If you live in the Residence Halls,
enter your Residence Hall name and room number in the second address line
Local address
Residence Hall and Room #
Local City
Local State
Local Zip

 

 

Eligibility Criteria

The following information is used to determine eligibility for SSS. Please read carefully!

 

ALL SECTIONS MUST BE COMPLETED AND SIGNED!

 

Income Status:
2023 family’s taxable income *

Household taxable income is household income after deductions are taken. (Line 15 on tax form 1040)

If your family income is "0", please enter "1" on this line.

 
Number of people in household *
Parent or Guardian Signature *
Please select a signature verification type.

 
Do you reside with
Do you (the student) have children?
Are you an independent student according to Financial Aid? If so, you can sign in the parent signature block.
Have you applied to Financial Aid

 

First Generation Status

Indicate the highest level of education that your parent(s)/guardian (s) has earned.

Parent or Guardian 1 *
Parent or Guardian 2 *

 

Learning, Psychiatric , or Physical Disability

You may apply for SSS if you have a medical, physical, sensory, cognitive, psychiatric, or brain related condition.

A detailed summary or form must be reviewed by the Disability Resource Center to qualify under this criteria. This information will outline the nature of how the condition affects you. This must be written by a physician or therapist that knows you. 

For more information, contact Disability Resource Center  

715-425-0740

drc@uwrf.edu

https://www.uwrf.edu/DRC/
Do you have a diagnosed learning, physical or psychiatric disability? *
Have you provided the expected kind of documentation to the Disability Resource Center? *

 

 
All the information provided on this page is true to the best of my knowledge. *

 

 

Individual Needs Assessment.

Please respond to the following statements

 

 
I am not sure which majors or careers would be a good fit for me. *

 
My high school classes prepared me for college *

 

 
I need to improve my math or writing skills. *

 
I have been out of school for more than five years. *

 
English is my second language. *

 
I have been in foster care (aged out), kinship, or guardianship care *

 
I, or my family, am homeless *

 

Tell us about you!

Please note that your responses to the following questions will help us decide if SSS is right for you.
Why do you want to be a scholar in the Student Support Services Program? How do you expect to use SSS resources to help you reach your goals and address challenges? *

 

 
Please describe the main concern(s) you have about being in college. *

 

 

Commitment to Participate

 

If accepted into the Student Support Services Program, I agree to the following:

  • I will attend the SSS New Student Orientation.
  • I will meet with my SSS Academic Coach regularly each semester.

  • I will attend the required SSS Events or workshops each semester (academic, financial literacy, retreats, cultural).
  •  I will review my Early Grade Awareness form with my SSS Academic Coach each semester.

  • I will attend all classes and complete coursework in a timely manner and participate in the tutoring program as needed throughout the academic year.

 

 
​I understand that I may lose my status as an SSS Scholar if I do not follow the terms of this agreement. *

 

Release of Information Consent

 

I hereby authorize the Student Support Services staff to access my academic records and to request attendance and performance information from my instructors on my behalf.

I hereby authorize my instructors to release such information. I release the staff of Student Support Services and my instructors from all legal responsibility or liability that may arise from the actions I have authorized.

I give my consent for University of Wisconsin– River Falls Student Support Services program to use my photo and provide information on my participation in the SSS program in the SSS website, Facebook page, brochures and newsletters. This agreement remains in effect during my years as a student at UW-River Falls.

Furthermore, I understand that by applying for the TRIO Student Support Services Program, I authorize the program staff to obtain records or data pertinent to my participation from other sources, and to release information as required by law or the terms of the Student Support Services grant, to the grant funding agency of the United States government.

The Student Support Services Program staff has my permission to communicate verbally and otherwise with staff,
faculty, and/or off campus professionals on my behalf.

 

 
Student Signature *
Please select a signature verification type.
Date *

 

 

Release of University Identification Photo

 

I hereby authorize the Campus Carding Office to release my photo ID picture, that the University of Wisconsin-River Falls has captured for the purpose of identification on the campus of UW-RF to Student Support Services.
I understand that I release the Campus Carding Office from any liability in which the department and person(s) of above
named department receiving said image may use the image for. I herein authorize the Campus Carding Office to release the photo in electronic form (via JPEG format) and/or as printed medium such as, but not limited to, an identification badge. I understand that the use of the ID image is not governed by the Campus Carding Office, and that I must enter into a separate agreement with the above named receiving department.
Name
Student Signature *
Please select a signature verification type.
Falcon ID *
Date *

 

 

Student Support Services is funded by the U.S Department of Education.

Acceptance into the program is contingent upon meeting eligibility criteria and space availability.

 

 Terms of Submission:

By submitting this application, I acknowledge that all of the above information is correct and accurate to the best of your understanding.