Submit Your Pre-Application



Thank you for your interest in our TRiO Student Support Services (SSS) program at Wallace Community College! TRiO is a federally funded program. In order to qualify to participate in the program, students must be: 1.) Enrolled or accepted for enrollment and intend on completing their degree at Wallace; 2.) U.S. Citizen or permanent resident; 3.) Have some level of academic need that could impact their ability to succeed; and meet at least one of the following: 1.) Have a low family income as determined by federal guidelines; 2.) Be a first generation college student (neither parent has a Bachelor's degree); or 3.) Have a documented disability. Please complete this pre- application as thoroughly as possible. You cannot save and restart this application. If you cannot complete the online form or have questions, please call our office at 334-556-2368 for Wallace/Dothan Campus or 334-619-3010 for the Sparks/Eufaula Campus.
General Information:
Last Name *
First Name *
Date: *
Student #
Date of Birth:(DD/MM/YYYY) *
E-mail Address: *
Address: *
City: *
State: *
Zip: *
Campus: * Dothan Sparks
Cell Phone Number *
Other Phone # *
Resident Status * Yes No
Ethnic Background: * African American Asian/Pac Islander Caucasian/White Native American Hispanic/Latino Other
Marital Status: * Single Married Divorced/Separated Widowed
Who referred you to the SSS program
First-Generation College Student:
Father's Educational Completion: * Grades 1-8 Grade 9 Grade 10 Grade 11 Grade 12
Does your father currently hold a Bachelor's degree * Yes No
Mother's Educational Completion * Grades 1-8 Grade 9 Grade 10 Grade 11 Grade 12
Does your mother hold a Bachelor's Degree * Yes No
Federal Eligibility Information:
Are you a Pell Recipient: * Yes No
You may be asked to provide a copy of your current Federal tax form 1040, 1040-EZ or 1040-A. If you did not file a tax return, please list the amount shown on your current End of Year Statements for all members of the family.
Child Support Received: *
Social Security Benefits Received: *
Veteran's Benefits Received *
Welfare Benefits Received (Do not include food stamps) *
Worker's Compensation Received *
Other taxed income and benefits *
Adademic Information:
Program of Study: *
Transfer Plans * Yes No Undecided
If you answered yes to the previous question, where do you plan on transferring? *
Sign and Submit
Applicant's Signature * Please select a signature verification type.