________________________________________________________________________________________________________________________________________

TRIO Student Support Services STEM Application

Thank you for your interest in applying to Jackson State University's TRIO Student Support Services STEM Program! 

Disclaimer: You cannot save and restart this application. 

Please take some time to gather required information needed to complete the application:

  • Most recent tax form (Line 15)
    • Dependent Student (Parent/Legal Guardian most recent tax information)
    • Independent Student (Your most recent tax information)
  • Family size (How many people live in your household?)

Application Requirements:

  • The most recent tax form can be uploaded to the application under Financial Information.
  • You may also provide the Most Recent Taxable Income under Financial Information.
    • Taxable income can be found on Line 15 of most recent tax form.
  • Parent/Legal Guardian must provide a signature under Financial Information if you are a dependent student. Please do not skip this step! 

If you have any questions, please call our offices at (601) 979-5023 or (601) 979-1054.
_______________________________________________________________________________________________________________________________________
Personal Information:
Last Name *
First Name *
Middle Name *
School ID ( J-Number) *
Contact Number *
Email Address *
Permanent Address *
Permanent City *
Permanent State *
Permanent Zip Code *
Demographic Information:
Date of Birth *
Gender *
Race/Ethnicity *
Do any of the following apply to you? *
Are you disable? *
Are you registered with JSU Student Disability Services? *
Has your mother received a Bachelor's degree? *
Has your father received a Bachelor's degree? *
Please check if you have no living parent (biological or adoptive)
Financial Information:
Have you completed your FAFSA form? *
Do you receive Federal Pell Grants? *
Do you provide your parent's information on the FAFSA form? *

: If you answered YES, you are required to provide your parent's/legal guardian's financial information and signatures. 

T: If you answered NO, you are required to provide your financial information only and your signatures.
What is your family's size? (include yourself) *
Most Recent Taxable Income (Line 15 of IRS Tax Return) *
Please upload MOST Recent IRS Tax Form

Please Read Carefully!

Parent/Legal Guardian signature is required ONLY for individuals whose tax filing status is DEPENDENT. 

If you are an INDEPENDENT student, please sign your name. 
Parent's or Independent Student's Signature *
Please select a signature verification type.
Academic Information:
Major: *
College Classification *
Are you a transfer student? *
Did you receive a degree from another college? *
What is your current GPA? *
Have you participated in any of the following TRIO programs? *
Sign and Submit: 
Applicant's Signature *
Please select a signature verification type.

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,.