TRIO Program Qualification Questionnaire

Thank you for your interest in Butler's TRIO Grant Program! In order to choose the most qualified students, we need to gather some information from you. Please know that your responses to these questions are confidential and will not be shared or used for any other purposes.

If you have any questions about this program, please contact us at

Student ID:

First Name:   Middle Initial:   Last Name:

Date of Birth (mm/dd/yy):

Have you declared a major?
Yes   No

Do you intend to transfer?
Yes   No

Is English your first language?
Yes   No

Are you currently in or have aged out of foster care?
Yes   No

Are you homeless?
Yes   No

What is the best email address for you?