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If you have already achieved a 2 to 4 year degree you do not qualify for this program.

A# (Include the A)

Enter the information below

If yes, you do not qualify for the program

Household Members

Highest educational or grade level completed by your parent(s) that you live. (Check one for each.)

Enter Disability Status, if any

 (Check all that apply to you.)

If accepted in COPE/Experience VU Student Support Services (SSS), I agree to the following:


  • I will attend the SSS Program’s New Student Orientation and University Experience course (SSKL 006).
  • I will be honest and conscientious during my meetings with my SSS Program professional. Additional participation may be required via tutoring, workshops, cultural events, or academic enhancement.
  • I will review my mid-term grades each semester and discuss with my Program professional.
  • I will contact the COPE SSS main office each semester regarding advising for the next semester.
  • I will attend all classes and complete all work in a timely manner. COPE SSS receives notices when our students do not attend classes, miss assignments, and perform well in classes.
  • I will contact Program professionals when I am unable to attend scheduled appointments/events.
  • I give my consent for Vincennes University SSS Program to use my photo/video and provide information on my participation with the SSS Program. This agreement remains in effect during my years as a student at Vincennes University.


I understand that I may lose my status as a SSS participant if I do not follow the terms of this agreement.


I certify that the information I have provided on this application is, to the best of my knowledge, complete, and correct.

Furthermore, I understand that by applying for the TRIO SSS Program, I authorize the Program professional to obtain records or data pertinent to my participation from other sources, and to release information, as required by law or the terms of the SSS grant, to the grant funding agency of the United States government. The SSS Program professionals have my permission to communicate with university staff and faculty, family members or others, community agencies and/or off campus professionals on my behalf. I release the Staff of SSS from all legal responsibility or liability that may arise from the actions I have authorized.

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