Louisiana State University-SSS

Louisiana State University

SSS Application
- Name*
  
  First NameMiddle NameLast Name
- LSU 89 number (if applicable)
- Email address (LSU preferred)*
  example@example.com
- Are you a U.S. Citizen or U.S. permanent resident?*

Louisiana State University

SSS Application
- Date of birth*
  
  MonthDayYear
  mm-dd-yyyy
- Your cell phone number*
  (999)999-9999
- Secondary phone number*
  (999)999-9999
- Permanent mailing address (not on LSU campus)*
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Postal / Zip Code
- Emergency contact name*
- Emergency contact phone number*
  (999)999-9999
- Our office understands that the language used in this survey may not accurately reflect members of the LGBTQ+ community. Unfortunately, these questions are required by the U. S. Department of Education. We also understand that these questions may be triggering for some individuals. There are campus resources available through the LGBTQ+ Project (lsu.edu/lgbtqproject/) and the Student Health Center (lsu.edu/shc/). There are also national hotlines that you may call including (thetrevorproject.org/).
- Please identify your biological sex*
- What are your pronouns?
  
  Other
- Are you Hispanic or Latino/a/x*
- Regardless of your answer above, select all that apply*
  
  Other
- Are you married?*
- Do you have a child/children*
- Did you graduate from high school?*
- What high school did you graduate from*
  
  Name
  
  Street Address Line 2
  
  City/TownState
  
  Postal / Zip Code
- Did you attend more than one high school?*
- Is English your first language?*
- Select any TRIO programs in which you have previously participated*
- If you previously participated in TRIO programs, identify home institution (i.e. Cope, ULL, SELU, UNO, ULM, etc.)*
- What is your t-shirt size?*
- Do you have a documented Disability?*
- Have you contacted and/or registered with the LSU Disability Services?*
- Please identify with their full name, your natural or adoptive parent #1
  
  First NameLast Name
- Please identify with their full name, your natural or adoptive parent #2
  
  First NameLast Name
- Please mark the highest level of education achieved by parent #1 (excluding grandparents, stepparents, and guardians).*
- Please mark the highest level of education achieved by parent #2 (excluding grandparents, stepparents, and guardians).*
- Were you raised by someone other than your natural or adoptive parents?*
- If you did not reside with or receive support from a natural or adoptive parent, were you*
  
  Other
- If yes, please tell us who raised you?*
- How long did you live with them?*
- Were they your legal guardian?*
- Select all of the following that were received by you or your family during the most recently completed income tax year.*
  
  Other
- Do you give permission to SSS to receive your financial information (specifically ISIR income verification) from the LSU Student Aid Office?*
- I understand that in the event that the ISIR does not provide the necessary clarity to determine eligibility or in the event that I refused permission to SSS to receive that information from LSU Student Aid, I will have to to provide the necessary documents to move my application process forward*
- Please select the response that best describes your relationship to the student*
- Have you been accepted for enrollment at LSU?*
- What is your current enrollment status at LSU?*
- Which best describes your current enrollment status at LSU?*
- What year will you be for the upcoming semester?*
- What is your major at LSU?*
- What is your ultimate career goal?
- Have you completed the Free Application for Federal Student Aid (FAFSA)?*
- Have you received your financial aid award?*
- Select all financial aid that you were awarded*
  
  Other
- Where will you be living while attending LSU this semester?*
  
  Other
- Select all of the Advising and Counseling areas that you belive you will need in order to be successful at LSU*
  
  Other
- Please choose your TOP FIVE challenges that you may believe may negatively impact your academic goals*
  
  Other
- Please select at least five areas where you will need support in during your time at LSU*
  
  Other
- What are you hoping to gain by joining SSS?*
  
  Other
- How did you learn about SSS?*
  
  Other
- I understand that SSS 1001 is a required course for SSS membership and that I will be placed in the course*
- I understand that I will receive a phone call from an SSS staff member in the next couple of weeks to set up my interview if I am eligible for this program*
- I authorize that all information provided on this application, including my personal and academic data may be shared with TRiO Student Support Services (SSS) at LSU to assess the student's educational progress, evaluate the effectiveness of TRiO SSS program activities, complete TRiO program reporting requirements to the Department of Education, and for possible award nominations. This data will be attained in accordance with U.S. Department of Education requirements. To learn more about privacy at LSU, please see the LSU Privacy Statement at www.lsu.edu/privacy.*
- Consent to Disclose Financial Information
  
  In order to verify your eligibility for the TRIO Student Support Services program, we need to collect additional income-based information. Please complete this form, sign and date this document.
- PrintName
  
  First NameLast Name
- LSU ID
- I authorize the Financial Aid Office to disclose my federal tax information to the following entity/individual for the purpose of income evaluation and processing of TRIO Student Support Services application:
  
  Recipient: TRIO Student Support Services (SSS) Program
  
  Student Acknowledgment:
  
  I understand that I may revoke this consent at any time by providing written notice to the Financial Aid Office. However, any disclosures made before the revocation will not be affected.
- Student Signature
  
  Clear
- Date
  
  MonthDayYear
  Date
- The signing party agrees that this agreement may be electronically signed. The party agrees that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability and admissibility.
- In accordance, with the U.S. ESIGN Act, you may withdraw your consent to receive electronic documents, notices or disclosures at any time. In order to withdraw consent, you must notify the sending party that you wish to withdraw consent and request that your future documents, notices, and disclosures be provided in paper format. To request paper copies of documents; withdraw consent to conduct business electronically and receive documents, notices or disclosures electronically; or withdraw consent to sign document electronically, please contact the sending party at sss@lsu.edu.
- By signing this application, I attest that all the information is true*
  
  Clear

Louisiana State University

SSS Application
- Please verify that you are human*
- Should be Empty: