Thank you for your interest in our TRIO/Student Support Services program!  Please complete this application as thoroughly as possible.  You cannot save and restart this application.  You may want to review the included items, take some time to make notes and gather the required documents, and then return to submit your application.  If you have any questions, please email us at TRIO@my.westmoreland.edu
    General Information:
    School ID
    Last Name: *
    First Name: *
    Middle Name:
    Date of Birth: *
    Gender: (F) female (M) male
    Address: *
    Address 2:
    City: *
    State (PA): *
    Zip Code: *
    United States Citizen: *
    Home Phone
    Cell Phone Number:
    Westmoreland Email Address: *
    Ethnic Group/Race:
    American Indian or Alaskan Native *
    Asian *
    Black or African American *
    Hawaiian or other Native to Pacific Island *
    Hispanic *
    White *
    Academic / Family Info:
    Mothers Educational Level:
    Fathers Educational Level:
    Are you a High School Graduate/GED:
    How many people in your household at home? *
    Optional Information:
    Do you have a disability?

    If you have a disability and would like to request academic support services and accommodations, please contact Lauren Eicher at (724) 925-4000 ext. 3053 or email at eicherla@westmoreland.edu
    How did you learn of the TRIO Student Support Program? *

    Sign and Submit:

    Please be sure to use the Signature Pad to sign your application as well as type in your full name below the Signature Pad.

    click; I agree to terms click; Sign and Submit Signature, then click; Submit Application.
    Applicant Signature *
    Signature Type: Simple    Start Over
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    Signature: (Type in your full name)
    I agree to the terms included.
    Terms of Submission:
    By submitting this application, you acknowledge that all of the above information is correct and accurate to the best of your understanding. You are interested in being considered for a program that would provide assistance and support through counseling, tutoring, and other resources to help you achieve your education goals. You authorize the staff of TRIO/SSS to obtain information from your instructors, Admissions, Records, and Financial aid Offices pertinent to your participation in the program.