Bellarmine University

Section 1: Personal Information

Bellarmine Email

set device type

Bellarmine ID Number

First Name

Middle Name

Last Name

Birthdate

Cell Phone Number

Address

Country

Street

City

Region

Postal Code

Section 2: Academic Information

Current Program

GPA (on a 4.00 Scale)

GPA Type

Are you full ( completing 12 hours or more each semester) or part time?

Full Time

Part Time

Expected Bellarmine Graduation Date

Section 3: Eligiblity Information

Are you a first-generation college student?

Yes

No

Do you meet federal income eligibility guidelines?

Yes

No

Unsure

Are you currently eligible for or receiving finacial aid (Pell Grant, Work-Study, etc.)?

Yes

No

Section 4: Student Goals and Services Requested

Briefly describe your academic and career goals and how TRIO Student Support Services can support your goals:

Please describe other services:

What workshops/seminars are you interested in attending? (check all that apply)

Please describe other workshops:

Section 5: Certification and Signature

By signing below, I certify that all the information which I have provided is true and correct to the best of my knowledge. I understand that Student Support Services (SSS) staff will use the data provided on this application to assist in determining my eligibility for the program. I also consent to give SSS staff permission to request for the Bellarmine University Financial Aid Office to review and report back my FAFSA information as it relates to the Department of Health and Human Services Poverty Guidelines in order for TRIO to determine eligibility for the program, provide program services, and obtain potential grant aid.

Student Signature

Date

Bellarmine TRIO Student Support Services Application

Main Campus

About Us