Livingstone College-SSS

Student Application
- Name*
  
  First NameMILast Name
- Student ID No.*
- Mailing Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Gender*
  
  MaleFemale
- Social Security No.
  999-99-9999
- Cell Phone Number*
  (999)999-9999
- Home Phone Number
  (999)999-9999
- Date of Birth*
  
  MonthDayYear
  mm-dd-yyyy
- Livingstone College Email Address*
  example@example.com
- Personal Email Address
  example@example.com
- Race*
- Ethnicity*
- Are you a U.S. Citizen?*
  
  YesNo
- Are you a U.S. Citizen?*
- Current Classification (This is determined by your “earned credit hours”)*
- Current Course Load:*
- What is the highest level of education completed by Mother / Guardian?*
- What is the highest level of education completed by Father / Guardian? *
- Who do you live with?*
- If you are a depend, student please provide the following for the parent/ guardian you live with.
- Parent /Guardian 1 Full Name*
  
  First NameLast Name
- Parent Email*
  example@example.com
- Parent /Guardian 2 Full Name
  
  First NameLast Name
- Parent Email
  example@example.com
- JICS Username
- JICS Password
- Did your MOTHER graduate college with a 4-year?*
  
  YesNo
- Does she live in the home with you?*
  
  YesNo
- Did your FATHER graduate college with a 4-year?*
  
  YesNo
- Does he live in the home with you?*
  
  YesNo
- Are you receiving financial aid?*
  
  YesNo
- If No, the reason(s) being:
  
  Have not appliedWas not eligibleNeed help applying
- Are you receiving financial aid?*
- If No, the reason(s) being:
- Current Classification (This is determined by your “earned credit hours”)*
  
  Incoming Freshman (0)Freshman (1 – 25.99)Sophomore (26 – 57.99)Junior (58 – 90.99)Senior (91+)
- Current Course Load:*
  
  Full-time Student (12+ hrs)Part-time Student (under 12 hrs)
- When was your 1st semester at Livingstone?*
  
  MonthDayYear
  mm-dd-yyyy
- Do you have a documented disability?*
  
  YesNo
- If yes, have you registered with Livingstone College's Office of Disability Services?
  
  YesNo
- Do you have a documented disability?*
- Have you registered with Livingstone College's Disability Services Coordinator?
- Have you previously participated in a TRIO program?
- Have you previously participated in a TRIO program?
  
  YesNo
- Have you previously participated in a TRIO program (Student Support Services, Talent Search, or Upward Bound)?
- Which TRIO program did you participant in?
- Number of people living in PARENT/LEGAL GUARDIAN’s household? (Including yourself in the count)
- What was parents /legal guardian’s taxable income from previous year?
- Please upload verification of taxable income. (i.e. tax transcript or tax return form)
  
  Browse Files
  
  Cancelof
- *Taxable income can be found on Line 15 on federal tax form 1040
  
  I certify that all the information on this form is true and complete to the best of my knowledge. I also authorize Student Support Services permission to obtain and review any academic and financial documents needed to complete the application process.
- Student Signature
  
  Clear
- Date
  
  MonthDayYear
  mm-dd-yyyy
- Parent Signature
  
  Clear
- Date
  
  MonthDayYear
  mm-dd-yyyy
- What is your dependency Status?*
  
  Dependent Student - You live and supported by parent (s)/guardian(s).Independent Student - You are 24 years old, claim self on tax returns, or emancipated minor.
- Number of people living in household (including yourself)?
- What was household taxable income from previous year
  *Taxable income can be found on Line 15 on federal tax form 1040
- Please upload verification of taxable income. (i.e. tax transcript or tax return form)
  
  Browse Files
  
  Cancelof
- Income Statement Certification
  
  I certify that the information I have provided regarding my household size and taxable income for the previous tax year is accurate and true to the best of my knowledge.
- "Guardian/Parent" Signature (required for dependent students)
  
  Clear
- Date
  
  MonthDayYear
  Date
- *Taxable income can be found on Line 15 on federal tax form 1040
  
  I certify that all the information on this form is true and complete to the best of my knowledge. I also authorize Student Support Services permission to obtain and review any academic and financial documents needed to complete the application process.
- Signature
  
  Clear
- Date
  
  MonthDayYear
  mm-dd-yyyy
- Name*
  
  First NameLast Name
- Please check any needs that apply to you*
  
  Improve General Study HabitsImprove Time ManagementEnhance MemoryImprove Memory SkillsIncrease Reading SpeedIncrease Grade Point AverageMake Career DecisionsReduce Math AnxietyImprove Note Taking SkillsImprove Test Taking SkillsImprove Writing SkillsImprove VocabularyIncrease Reading ComprehensionDiagnose Learning DisabilityPlan College CoursesOther
- Check any of the following items which describe you:*
  
  Out of School Too LongDifficulty Finding Child CareFew Computer SkillsDifficulty Managing MoneyMay Need Personal CounselingAfraid of Failing CollegeAfraid I Might Not Fit In At LCPanic During TestsUnsure of College ProceduresLittle or No Experience on the InternetDifficulty Meeting DeadlinesOther
- What obstacle(s) would most likely prevent you from completing your academic goals?*
  
  Poor Study HabitsTaking the Wrong ClassesAlways WorryingEasily DistractedTake Things Too SeriouslyTrouble SleepingFeeling Depressed or SadFamily Medical ProblemsNo Close Friends at LCAlcohol and/or Drug ProblemsLack of MoneyAlways Feeling TiredToo ShyBad GradesProblems at HomeAfraid to Speak Up In ClassDealing with BillsSeparation or DivorceRecurring Health ConcernsNo Support From Family/FriendsOther
- Check any of the following services that may interest and/or benefit you while attending LC:
- Advising*
  
  Academic Advising/Registration AssistanceFinancial Aid Application AssistanceCareer Exploration/AdvisingIndividual support & Monitoring
- Graduate School Planning*
  
  ApplicationsPersonal StatementRecommendation LettersCollege Visits
- Loan Programs*
  
  Laptop ComputerGraphic CalculatorTextbooks
- Career Counseling*
  
  Career Assessment TestingSpeaking with a Professional in Your Area of InterestResume Assistance
- Tutoring Needs*
  
  EnglishScienceHistoryMathOther
- Please carefully read and answer the following questions using complete sentences. Please “(i.e. work, RA duties, organizations, etc.)”
- Why did you choose to attend Livingstone College?
- What are your education and career goals?*
- What other demands do you have on your time? (i.e. sports, residence hall assistant, club, organization, Greek life, etc…)*
- What support might you need to complete your goals?*
- Are you interested in leadership training?
- I certify that the details provided in this application are accurate to the best of my understanding, and I authorize the TRIO program staff to attain and review my academic, financial, and disability information to confirm my eligibility for TRIO programs.
- Signature
  
  Clear
- Date
  
  MonthDayYear
  mm-dd-yyyy

Student Application