TRIO Disability Support Services

Income Verification Form

TRIO Disability Support Services (DSS) is a federally funded program at WSU that provides opportunities for academic development, financial assistance, and encourages students pursuing a bachelor's degree.

For all federal TRIO programs, income is a factor in determining eligibility. Please indicate your family size (including yourself) and estimated household taxable income below. If you have any questions regarding this form, please call 316-978-5949 or email trio.dss@wichita.edu.

Please submit this form either as a dependent student or independent student (see definitions below). 

For a dependent student (under the age of 24, unmarried, no children), this form must be completed and signed by your parent/guardian. The link to this form may be easily copied and sent to a parent/guardian so they can complete it. 
Dependent Student:
Student Name
Parent Name
Family Size
Estimated annual household taxable income:
I certify that the above information is true and correct to the best of my knowledge. 
Date:
Parent Signature
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.

OR

For an independent student (over the age of 24, or married, or have children, or active military duty/veteran, or were in foster care), this form must be signed the student.  
Independent Student:
Student Name
Family Size (including yourself)
Estimated annual household taxable income:
I certify that the above information is true and correct to the best of my knowledge. 
Date:
Student Signature
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.