Avila University-SSS-Application Form

  • AVILA UNIVERSITY

    Student Support Services
    Application Form

    TO QUALIFY YOU MUST BE:

    A first-generation college student (see explanation in Section II. Eligibility Information) AND/OR meet federal income guidelines AND BE a United States citizen or permanent resident

    Statement of Confidentiality: The information contained in this application is for the purpose of determining the applicant’s eligibility for the Student Support Services Program. Information received is confidential.

    • I. Applicant Information 
    • Date of Birth*
       - -
    • Are you currently on an Avila Athletics team?
    • Sex*
    • Citizenship Status*
    • Marital Status
    • Ethnicity: Are you Hispanic/Latinx?*
    • Race*
    • Have you participated in any of these programs?
    • Are you a transfer student
    • I live (or plan to live) on campus
    • Do you intend to earn a bachelor's degree from Avila?*
    • II. Eligibility Information 
    • Parent/Guardian 1
    • Highest level of education completed by this parent/guardian
    • I regularly resided with and received support before my 18th birthday from this parent/guardian
    • Parent/Guardian 2
    • Highest level of education completed by this parent/guardian
    • I regularly resided with and received support before my 18th birthday from this parent/guardian
    • Are you a first-generation college student? (First-generation college student: neither parent has a bachelor’s degree or, if you regularly resided with and received support from only one parent, that parent did not complete a bachelor’s degree.)*
    • Are you independent (emancipated or marked independent on FAFSA)?*
    • Are you receiving financial aid?*
    • If no, why
    • Would you benefit from services due to a disability?
    • If yes, will you or have you filed for services with Avila’s disability services office?
    • Are you currently on academic probation?
    • Are you currently having difficulties in one or more classes?
    • III. Education and Academic Need 
    • Which services are you interested in learning more about or receiving? (check all that apply)*
    • Other consideration (check all that apply)
    • IV. Statement of Verification, Agreement, and Consent 

    • My signature below indicates that, to the best of my knowledge, I have given you on this application true statements, complete and accurate. With my signature, I hereby grant permission to Student Support Services Inspired to Achieve to gather my ACT scores, financial aid reports, transcripts, and other necessary information in order to provide the services I have requested and to make reports to the US Department of Education for the re-funding of this program. I also authorize SSS Inspired to Achieve to obtain periodic reports from my instructors regarding my academic progress for courses in which I am enrolled. I understand that all information will be kept confidential and will be used for the following purposes: 1) student demographic data and record keeping, 2) program evaluation, 3) needs assessment, 4) federal reporting, 5) other administrative purposes. I grant permission to use photographs, quotes, accomplishments, statements, and/or print my first and last name in any publications for Student Support Services Inspired to Achieve.

      I have read and agree with the Statement of Verification, Agreement, and Consent.

    • Date
       - -
    • Clear

    • BRING COMPLETED APPLICATION OR MAIL TO:

      Avila University
      TRIO Office, Hodes Center
      11901 Wornall Rd
      Kansas City, MO 64145

      Phone: (816) 501-2439 E-Mail: inspiredtoachieve@avila.edu

    • Submit 
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