Thank you for your interest in Disability Support Services (DSS). Please complete this application as thoroughly as possible. You cannot save and restart this application, so you may want to review the included items and gather any information needed to accurately answer the questions below.

If you have any questions about this application, please call (316) 978-5949, email trio.dss@wichita.edu, or stop by our office in the Shocker Success Center #223 (main campus).

General Information:

First Name *

Middle Name

Last Name *

WSU ID *

Date of Birth *

Gender *

Marital Status *

Address *

Address Line 2

City *

State *

Zip *

Cell Phone Number *

Would you like to opt-in to receive texts from DSS?

Email Address *

Preferred Contact Method

Ethnicity/Race *

If multi-racial was selected, please list them here

Eligibility Information:

U.S. Citizen *

Do you have a documented disability? *

Highest Level of Education that Your Parent(s)/Guardian(s) Completed:

Mother/Guardian *

Father/Guardian *

Have you completed the Free Application for Federal Student Aid (FAFSA)? *

Are you receiving a Pell grant? *

Academic Information:

Are you currently enrolled at WSU? *

Class Standing *

When was/will be your first semester at WSU? (Fall 2023, Spring 2027, etc.) *

If you have been a WSU student prior to this semester, please upload your unofficial transcript here:

Number of credit hours enrolled in: *

Are you currently on academic probation? *

Do you plan to earn a bachelor's degree from WSU? *

Major *

What is your target graduation date? (semester/year) *

Have you previously participated in any of the following programs:

Are you currently participating in any of the following TRIO programs at WSU? *

Are you registered with the Office of Student Accommodations and Testing (OSAT)? *

If yes, I authorize TRIO DSS to verify my disability documentation submitted with the WSU Office of Student Accommodations and Testing.

OR

Please upload your documentation of disability here:

The following are important issues relevant to your success at WSU. Please identify areas you would like assistance with or would like to learn more about.

Financial Literacy (Personal Finance/Budgeting)

Career Advising

Academic Advising

Tutoring

Graduate School Advising

Study Skills Development

Financial Aid Advising

Personal Advising

University Resources and Services

How can TRIO DSS help you in accomplishing your educational goals?

What is your primary reason for applying to TRIO DSS? *

How did you hear about TRIO DSS? *

Acknowledgements and Authorization

To the best of my knowledge, all the information provided on this application is true and complete. I understand that TRIO Disability Support Services will use the information provided on this form to assist in determining eligibility and all information will be kept confidential. I understand that this TRIO DSS application is an educational record as that term is defined under the Family Education Rights and Privacy Act (FERPA). I authorize TRIO DSS to share relevant information with other WSU staff/faculty as it pertains to my disability status and/or educational success.

I authorize TRIO DSS to obtain my academic records, including high school and/or college transcripts, course registration, grades, and other information necessary to provide the services I have requested.

I give my permission to release my name and/or photo to provide recognition in the TRIO DSS newsletter, website, and other publications, and to Wichita State University staff in the performance of their duties.

Student E-Signature *

Signature Type: Simple Start Over

Signature: (Type in your full name)

I agree to the terms included.