Tusculum University SSS

Today's Date

MonthDayYear
mm-dd-yyyy
Please choose one:

Online StudentGreeneville On-campus Resident/Commuter Student
Application

P.O. Box 5053, Greeneville, TN 37745
sss@tusculum.edu, (423) 798-1635 Ext 5635
Fax: (423) 787-8494

To receive its annual funding of $348,515 from the U.S. Department of Education, Student Support Services (SSS) is federally required to submit certain personal information. Your safety and security are important to us and the information provided will be held in strictest confidence.

Educational Background
Previous participation in other Federal TRIO programs

Talent Search (not Duke Talent Identification Program)Upward BoundEducational Opportunity Centers (EOC)Other
Previous college(s) attended (Name/City/State)
Dates attended

Disability Information
If you need to inform the Tusculum ADA coordinator of a disability to receive accommodations, please contact adaservices@tusculum.edu.
Do you have a documented disability that can be verified with Tusculum’s ADA coordinator?*

YesNo
If yes, have you filed your disability with Counseling and ADA Services (counselingandadaservices@tusculum.edu?

YesNo
In order to provide you with needed support, please list or describe your disability?

Income Information
Please check one*

Dependent student (claimed by a parent or guardian on their taxes).Independent student (at least 24 years old by Dec. 31, orphan or ward of court at 18 years old, married, veteran or active duty military, have legal dependents, or homeless as a minor.
Applicants must submit a copy of their parents/guardians most recent tax return (form 1040). Please submit the tax return of the parent or guardian who claims the student as a dependent.
Tax Return

Browse Files

Cancelof
OR

If you are unable to attach your parent's/guardian's tax return, your parent/guardian must answer the questions below.
1. What is your family size according to your most recent tax return (spouse plus dependents listed)? *
2. Enter your taxable income as reported on the most recent income tax return: *
Taxable income is LESS THAN “adjusted gross income” and is listed further down on your tax return.
3. I did not file taxes last year for the following reasons (please check)*

Social SecurityUnemploymentDisabilityVeteran’s benefitsAFDCChild Support
Please read the following disclosure and sign your consent.

By completing this application, which will serve as a statement of income, I am certifying that the information furnished regarding family size and taxable income is true to the best of my knowledge.

I agree to waive my rights under the Family Privacy (Buckley) Amendment, and agree to permit the Student Support Services Program staff to access my grades and academic history. I am providing written consent for the redisclosure of my Federal Tax Information by the Office of Financial aid to include Student Support Services and with my further express written consent obtained by an institution of higher education, the redisclosure of FAFSA information pursuant to the terms and conditions of 20 U.S.C. § 1098h(c). I understand this information will remain confidential and only utilized in determining eligibility and necessary services.

I give my permission for Tusculum University SSS to use my image/likeness in or on SSS related publications and/or public relations materials. Such items may include: newsletter, website, video, handbook, brochures and social media.
Student Signature (please use mouse or your finger to sign):*

Clear
Please use your mouse or finger to sign
Dependent Students: The parent/guardian on the FAFSA must be the parent/guardian who provides consent on this application.
Parent/Guardian #1 Name (please type):

First NameLast Name
Parent/Guardian #1 Signature (please use your mouse or finger to sign):

Clear
Please use your mouse or finger to sign
Parent/Guardian #2 Name (please type):

First NameLast Name
Parent/Guardian #2 Signature (please use your mouse or finger to sign):

Clear
If you have any questions about how to complete this application, please contact SSS at (423) 798-1635 or sss@tusculum.edu.
Date

MonthDayYear
mm-dd-yyyy