Student Support Services

Per. Federal Regulations: “Hispanic/Latino refers to a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. As such, every Hispanic/Latino person has an associated race(s).”

*While we respect the Gender Identity of all students, we are required to report Legal Sex as part of federal requirements.

Financial Statement of need

(The taxable income can be found on the U.S. Individual Income Tax Return - IRS form 1040 see line 11b). NOTE: Family is defined as anyone who claims you as a dependent on their taxes regardless of your age - IF YOU ARE AN INDEPENDENT STUDENT – You must to enter your taxable income information

All information I have submitted on this form is true and complete. I understand this information is confidential and will be used for statistical and verification purposes. Further, in order to verify my eligibility and in the event that I am accepted to the Success at Southern/ TRIO-Student Support Services (SSS) at Southern Oregon University, I release the following information to the Success at Southern/TRIO-SSS Program:

• Southern Oregon University Academic and Admission/Registration/Financial Aid Documentation
• Southern Oregon University Interdepartmental Consultation
• Midterm and Final Grades Information
• Disability Documentation
• Income Information (Federal 1040 or other appropriate income documentation if required)

Additionally, (1) I agree to complete an exit interview in the event of withdrawal, transferring, or graduation from SOU.
(2) I understand that Success at Southern/TRIO-SSS administrators will contact my instructors on an as needed basis.

PLEASE CHECK THAT YOU HAVE COMPLETED AND HAVE ANSWERED ALL QUESTIONS. FAILURE TO COMPLETE IT WILL RESULT IN YOUR APPLICATION BEING REJECTED.

IMPORTANT: We like to recognize student achievements. Do you grant permission to include your name or picture for program related publicity, exhibits or displays? Please indicate preference by initialing: