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 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.

 

For a dependent student (under the age of 24 and unmarried), this form must be completed and signed by your parent/guardian. The link to this form may be easily copied and sent to this person so they can complete it. 

OR

For an independent student (over the age of 24, or married under the age of 24), this form must be signed the student.

 
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. 
Parent Signature
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.

 

OR

  
Independent Student:
Student Name
Family Size
Estimated annual household taxable income:
I certify that the above information is true and correct to the best of my knowledge. 
Student Signature
Signature Type: Simple    Start Over
Signature: (Type in your full name)
I agree to the terms included.