TROY Rides Application

* = required fields

学期* 2024年春季

Student Cont行为 Information

名字*

M.I.

姓氏*

Phone Number (Preferred for cont行为) *

Triton Email Address *

Emergency Cont行为 Information

Emergency Cont行为 Name

Emergency Phone Number

Address(es) for Lyft Transporation

Note: To have address on file, students must provide proof of residency, employment, and clinical.
For example, proof of residency, work schedule, or class schedule.

家庭住址*

恰当的#

城市*

国家*

邮政编码*

Enter work address information, if applicable

工作名称

工作地址

Enter clinical address information, if applicable

临床的名字

Clinical Address

Student Demographic Information

Triton Colleague ID *

Date of Birth *

Racial Identity *

Self-identification is important, and we understand that we each have our own understanding of the words used to describe our own experiences. So that we can best honor your identity and experiences, please select (as many as you want) from the list below.

Select the pronouns you use. 她/她/她的他/他/他的 They/Them/Theirs 泽/ Hir / Hirs 没有代词没有偏好未列出的 Decline To Answer

Additional Information

Are you a PELL Grant recipient? *

Did you 应用 for FAFSA/R.I.S.E. 行为? *

What is your housing situation today? Check all that apply. * I have a steady place to live I have a place to live today, but I am worried about losing it I do not have a steady place to live Decline to answer

What are your concerns about your housing situation? Check all that apply. * Condition of housing Lack of permanent housing Ability to pay rent and/or utilities Safe environment 没有问题其他 Decline to answer

Are you facing any food insecurities? *

Would you like to receive information regarding nutrition resources. (i.e., food banks/pantries, snap benefits) *

Student Verification

By signing this application, I attest that all the information on this application is true and accurate. I authorize the release and disclosure of official school records to Student Services; understanding that the information in these records will be used only to assess need for program services, including monitoring program progress, evaluate the effectiveness of 特洛伊骑, and fulfill program reporting requirements. I also allow Student Services and 澳门赌博平台 to use my image for program promotional purposes.

Verification Confirmation *(represents electronic signature)

Date * (mm/dd/yyyy)

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