TROY Rides Application

* = required fields

Semester * Spring 2024

Student Contact Information

First Name *

M.I.

Last Name *

Phone Number (Preferred for contact) *

Triton Email Address *

Emergency Contact Information

Emergency Contact 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.

Home Address *

Apt #

City *

State *

Zip Code *

Enter work address information, if applicable

Work Name

Work Address

Enter clinical address information, if applicable

Clinical Name

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. She/Her/Hers He/Him/His They/Them/Theirs Ze/Hir/Hirs No Pronoun No Preference Not Listed Decline To Answer

Additional Information

Are you a PELL Grant recipient? *

Did you Apply for FAFSA/R.I.S.E. act? *

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 No concerns Other 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 Troy Ride, and fulfill program reporting requirements. I also allow Student Services and Triton College to use my image for program promotional purposes.

Verification Confirmation *(represents electronic signature)

Date * (mm/dd/yyyy)

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