Southwest Texas Junior College-SSS

Name*

First NameMiddle NameLast Name

Date of Birth*

mm-dd-yyyy

SWTJC Student ID*

Mailing Address*

Street Address

Street Address Line 2

CityState

Zip

Email*

example@swtjc.edu

Alternate Email

example@example.com

Phone Number*

(999)999-9999

Alternate Phone Number

(999)999-9999

Preferred method of contact*

PhoneEmail

Time(s) of day you are most available:

8AM-12PM12PM-3PM3PM-6PM

Day(s) of week you are most available

Gender*

MaleFemalePrefer not to say

Race*

Ethnicity*

Hispanic or LatinoNon-Hispanic

Are you a U.S. Citizen?*

YesNo

Are you an Eligible Non-Citizen/Permanent Resident?*

YesNo

Marital Status*

Single (never married, divorced, separated, widowed)Single ParentMarried / Common-Law

Work Schedule

Not EmployedPart-TimeFull-Time

First-Generation Status

Did either of your parents graduate with a four-year/Bachelor's Degree in the U.S. or out of the country?*

YesNo

Disability Information

Do you wish to disclose a documented disability?

YesNo

For more information please complete an application for Disability Support Services at SWTJC here: https://amacsam.quickbase.com/db/bnzkej7g4?a=nwr?

Financial Information

Are you receiving Financial Aid for 2024-2025?*

YesNo

*If you answered “No” please scan in a signed copy of your parents’ or guardians’ most recent federal income tax information (Form 1040 pages 1 and 2) if you are a dependent OR a signed copy of your most recent federal income tax information (Form 1040 pages 1 and 2) if you are an independent student to triosss@swtjc.edu.

Who claims you as a dependent on federal income taxes?*

Yourself (independent)Parent/Guardian (dependent)

Complete the information below using your 2023 income tax return (IRS Form 1040):

Did you file a federal income tax return for 2023?*

YesNo

What was your taxable income in 2023?*

(IRS Form 1040, Line15)

How many family members are in your household?*

Have you participated in any of the following programs?

Student Support ServicesEducational Talent Search (ETS)Upward Bound (UB)Educational Opportunity Center (EOC)College Assistance Migrant Program (CAMP)High School Equivalency Program (HEP)

Please select any services you are interested in:

Emergency Contact Name

First NameLast Name

Relation

Phone Number

(999)999-9999

How did you hear about us?