University Of Wisconsin-Superior-SSS

A federally funded program by the U.S. Department of Education
- Name*
  
  FirstM.I.Last Name
- Student ID*
- Gender Pronouns
- Gender*
- Date of Birth *
  
  MonthDayYear
  mm-dd-yyyy
- Cell Number*
  (999)999-9999
- E-Mail Address*
  example@example.com
- Are you a U.S. Citizen?*
  
  YesNo
- Ethnicity/Race: Check all that apply*
  
  First Nation TribeAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or Other Pacific IslanderWhiteOther
- First Nation Tribe*
- Do you come from a Low Income family? *Refer to L.I. statement below*
  
  YesNo
- Did either of your parents graduate with a 4-year college degree?*
  
  YesNo
- Do you have a documented physical, psychological or learning disability?*
  
  YesNo
- 5. Is this your first Bachelor's Degree?*
  
  YesNo
- Some obstacles I face are*
  
  Low high school gradesLow admission test scoresPredictive indicatorAcademic proficient testsLow college gradesHigh school equivalencyFailing gradesOut of the academic pipeline for 5 or more yearsOtherLimited English proficiencyLack of educational and/or career goalsLack of academic preparedness for college level Course workNeed for academic support to raise grade(s) in required course(s)/academic major
- LOW INCOME Statement: Low Income status will be determined using either the Dependent or Independent Income Verification Forms. You are a dependent if your parent/guardian claimed you on their taxes.
  FIRST GENERATION Statement: First Generation status will be determined using information entered on the application for admission to UW Superior.
  DISABILITY Statement: You must be registered with Disability Student Services at UWS.
- Student's Signature*
  
  Clear
- Today’s Date*
  
  MonthDayYear
  mm-dd-yyyy
- Preferred Name*
- Major*
- Best way to contact you?*
  
  CallEmailText
- Academic Year (Fr/So/Jr/Sr)*
- Local Address*
  
  Street Address
  
  Apt/Box
  
  CityState
  
  Zip
- First Semester at UW-Superior*
  Semester/Year
- Parent/Guardian Email*
  example@example.com
- If yes, did you file income taxes as a dependent or an independent last year?*
  
  DependentIndependent
- Are you or have you ever been a member of any of the following TRIO programs?*
  
  EOC (Educational Opportunity Center)Talent SearchMcNairBridge Program- UWSGear-UpUpward BoundStudent Support Services
- PLEASE TELL US WHERE*
- How did you hear about Student Support Services?*
- 1. Are you a parent?*
  
  YesNo
- 2. Are you a veteran?*
  
  YesNo
- 3. Do you take 100% classes online?*
  
  YesNo
- 4. Can we invite you to social media pages?*
  
  YesNo
- 6. Are you an Athlete?*
  
  YesNo
- 7. Do you have an on campus job?*
  
  YesNo
- 8. Do you have an off campus job?*
  
  YesNo
- Do we have your permission to sign you into meetings and events that you can not attend in person?*
  
  YesNo
- Student Name*
  
  First NameLast Name
- Student ID#*
- Check all that apply
- I would like extra help with*
  
  Time ManagementPrioritizing TasksReading TextbooksTaking NotesTest PrepStaying OrganizedMaintaining WellnessAcademic planningSelecting a majorCareer counselingFiling my FAFSAScholarshipClass registrationFinding internshipsFinancial planningTutoringFinancial LiteracyAttendanceMoney challengesOnline or virtual routines
- I would be most likely to participate in activities that*
  
  Are related to my career goalsHelp me meet new peopleAid me academicallyAre on campusAre off campusAre recreational in natureAre service orientedAre outdoorsAre physicalAre cultural
- I would like to know how the SSS Program can help me with*
- After I graduate I plan to*
  
  Go on to graduate schoolEnter the workforceOther
- 2019-2020 Low-Income Eligibility Certification Independent Students: Based on 2018 Federal Household Taxable Income and Family Size
- Student Name*
  
  First NameLast Name
- SID*
- Fill this Portion If You WERE Required to File 2018 Federal Income Taxes
  
  Please use the table below to look up your family size and compare your 2018 taxable household income to see if you meet the low-income levels as published by U.S. Dept. of Health
- Size of Family Unit*
- 2018 Household Taxable Income: $*
- Taxable income can be found on 2017 Federal Tax Forms:
  1040EZ: Line 6; 1040A: Line 27; 1040: Line 43
  
  Student: My 2018 household taxable income and size of family unit are within the low-Income levels and therefore, I certify that my household qualifies as low-income
- Student Signature*
  
  Clear
- Date*
  
  MonthDayYear
  mm-dd-yyyy
- For family units with more than eight members, add the following amount for each additional family member: $6,480 for the 48 contiguous states, The term "low-income individual" means an individual whose family's taxable income for the preceding year did not exceed 150 percent of the poverty level amount.
- Fill this Portion If You WERE NOT Required to File 2018 Federal Income Taxes
  
  I was not required to file taxes due to income level for 2018 year. I certify that my household qualifies as low-income.
- Student Signature*
  
  Clear
- Date*
  
  MonthDayYear
  mm-dd-yyyy
- Fill this Portion If You and/or Your Parent/Guardian WERE Required to File 2018 Federal Income Taxes
  
  Please use the table below by looking up your family size and compare your 2018 taxable house-hold income to see if you meet the low-income levels as published by U.S. Department of Health and Human Services.
- Size of Family Unit*
- 2018 Household Taxable Income: $*
- Taxable income can be found on 2017 Federal Tax Forms:
  1040EZ: Line 6; 1040A: Line 27; 1040: Line 43
  
  Dependent Student: Our 2018 household taxable income and size of family unit are within the low-Income levels and therefore, I certify that our household qualifies as low-income.
- Student Signature*
  
  Clear
- Date*
  
  MonthDayYear
  mm-dd-yyyy
- Parent/Guardian of Dependent: Our 2018 household taxable income and size of family unit are within the lowincome levels and therefore, I certify that our family household qualified as low-income.
- Parent/Guardian Signature*
  
  Clear
- Date*
  
  MonthDayYear
  mm-dd-yyyy
- For family units with more than eight members, add the following amount for each additional family member: $6,480 for the 48 contiguous states, The term "low-income individual" means an individual whose family's taxable income for the preceding year did not exceed 150 percent of the poverty level amount
- Fill this Portion If You and Your Parent/Guardian WERE NOT Required to File 2018 Federal Income Taxes
- Dependent Student: I was not required to file taxes due to income level for 2018 year. I certify that our household qualifies as low-income
- Student Signature*
  
  Clear
- Date*
  
  MonthDayYear
  mm-dd-yyyy
- Parent/Guardian of Dependent: I was not required to file taxes due to income level for 2018 year. I certify that our household qualifies as low-income
- Parent/Guardian Signature*
  
  Clear
- Date*
  
  MonthDayYear
  mm-dd-yyyy