Tusculum University - Knoxville-SSS

Student Support Services – Knoxville, TN

(865)539-7403

arches@tusculum.edu

To receive its annual funding of $272,364 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.
GENERAL INFORMATION
Date*

MonthDayYear
mm-dd-yyyy
Please choose one:*

Online StudentGreeneville On-campus Resident/Commuter Student
Campus Location*

GreenevilleKnoxvilleOnline
Tusculum Student ID:*
Name:*

FirstMiddleLast
Birth Date:*

MonthDayYear
Date
Tusculum Email:*
example@students.tusculum.edu
Personal Email:
example@example.com
Address:*

Street/P.O. Box

Street Address Line 2

CityState

Zip Code
Cell Phone Number:*
(999)999-9999
Home Phone Number*
(999)999-9999
First date of coursework at Tusculum:*

MonthDayYear
mm-dd-yyyy
Classification*

FreshmanSophomoreJuniorSenior
Gender:*

MaleFemalePrefer not to identify
Citizenship:*

U.S. CitizenTerritory ResidentPermanent VisaOther
Ethnicity:*

Hispanic/LatinoNon-Hispanic/Latino
Race:*

American Indian/Alaska NativeAsianBlack/African AmericanNative Hawaiian/Pacific IslanderWhite/Caucasian
EDUCATIONAL INFORMATION
High School Graduation Year:*
List previous universities/colleges:
Previous Participation in TRiO Programs:

Talent SearchUpward BoundEducational Opportunity Centers (EOC)Other
FINANCIAL AID INFORMATION
Have you applied for financial aid?

YesNo
If yes, will you receive aid for the upcoming school year?

YesNo
ELIGIBILITY INFORMATION
Does your mother/guardian have a 4-year college degree?*

YesNo
Does your father/guardian have a 4-year college degree?*

YesNo
Choose one:*

DEPENDENT student: Parent(s)/guardians claim student on their taxes, and student must use their income information to complete the FAFSA.INDEPENDENT student: Financially independent student who meets at least ONE of the following criteria: at least 24 years-old, a veteran or active duty military, an orphan or ward of the court at 18 years-old, married, has legal dependents, was homeless as a minor.
Choose one:*

I will provide my Income Tax Return (if independent) or my parent’s/guardian’s income tax return (if dependent)Report your taxable income and family size as listed on the most recent income tax form. Taxable income is LESS THAN “adjusted gross income” and is listed further down on your tax return.I did not file taxes because I received non-taxable income in the form of social security, Aid to Families with Dependent Children, Unemployment, Veteran’s Benefits, Child Support or Other
Attach a copy of parent(s)/guardian(s) income tax return (if dependent) or your most recent copy (if independent)*

Browse Files

Cancelof
Please indicate your taxable income as reported on your most recent tax return. Please note that taxable income is less than your "Wages, salaries, tips, etc." and is listed further down on your tax return.*

$0-$20,385$0-$27,465$0-$34,545$0-$41,625$0-$48,705$0-$55,785$0-$62,865$0-$69,945Write in your taxable income
Write in your taxable income:*
Non-taxable income received include: (select all that apply)*

Social SecurityAFDCUnemploymentVeterans benefitsChild SupportOther
What is the number of persons in your family (including yourself, spouse, dependents) as listed on your income tax return?*
DISABILITY INFORMATION
Do you have a documented disability that can be verified with Tusculum’s ADA coordinator?*

YesNo
If yes, have you made a request for disability accommodation through Counseling & ADA Services?

YesNo
In order to provide you with needed support, please list or describe your disability?
If you need to inform the Tusculum ADA coordinator of a disability to receive accommodations, please contact adaservices@tusculum.edu.
SERVICES NEEDED
Please check all areas in which you would need assistance, instruction, or information*

Academic AdvisingGraduate School Info/VisitScholarshipsFinancial Aid InfoCultural Enrichment/Field TripsMentoringCareer Skills GuidanceComputer Skills AssistanceCounselingStudy Skills EnhancementStudent Success SkillsTutoringPersonal Finance CounselingOther
Additional information that may help program staff assist you?
How did you hear about the ARCHES program?
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
You can use either your mouse or finger (if using a tablet) 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
Parent/Guardian #2 Name (please type):

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

Clear
Date Signed

MonthDayYear
mm-dd-yyyy
If you have any questions about how to complete this application, please contact ARCHES at (423) 636-7300 Ext. 5901.