University Of Texas-El Paso-SSS-Application Form

Student Support Services (SSS) New Student Application
All information provided will be held confidential and used for SSSP Project purposes only.
- 1. Name:*
  
  First NameMiddle InitialLast Name
- 2. Student ID:
- 3. I am a U.S. Citizen*
  
  YesNo
- OR
- Permanent Resident:
  
  YesNoOther
- 4. Mailing Address:
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- 5. Cell Phone #:
  (999)999-9999
- Is it OK to Text Me:
  
  YesNo
- 6. E-mail Address:*
  example@example.com
- School E-mail:
  example@example.com
- 7. Date of Birth:
  
  MonthDayYear
  mm-dd-yyyy
- Age:
- Gender:
- 8. Class Level:*
  
  Freshman (1st year in college)Freshman (less than 30 hours)Sophomore (more than 30 hours)Junior (more than 60 hours)Senior (more than 90 hours)
- 9. What ethnicity do you identify with? (Please check all the boxes that best describe you)
  
  American Indian or Alaskan NativeNative African or African AmericanMiddle EasternNative Hawaiian/Pacific IslanderAsian American or AsianLatino or HispanicCaucasian (white)Other
- 10. Emergency Contact information:
- Name:
  
  First NameLast Name
- Phone:
  (999)999-9999
- Relationship:
- Street Address:
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- 11. How did you hear about the SSS Project?
- Do you currently have an Associate's or Bachelor's Degree?
  
  NoYes
- If Yes, which type of degree and major:
- Graduation Year & College:
- Do you have a documented disability?
  
  YesNo
- Are you registered with the Center for Accommodations and Support Services (CASS)?
  
  YesNo
- Have you applied for financial aid this academic year?*
  
  YesNo
- Please check only one of the following indicating your current status:*
  
  Dependent Student - Under 24 years of age, single, have no children OR children receiving less than half of their support from youIndependent Student - Over age 24, married, a veteran or active military, have children who receive more than half of their support from you, OR an orphan or ward of the court.
- Please indicate which Education Programs (EOPS) you have participated in (Check all that apply):
  
  Talent SearchGEAR UPUpward BoundNone/Not applicableOther
- What is your major/academic program?
- What are your career goals?
- What are your academic concerns?
- How do you feel the SSS Project can assist you? Please check as many as apply:*
  
  TutoringFinancial Aid InformationFAFSA AssistanceCareer ExplorationAcademic AdvisingTest Taking & Study SkillsGraduate School InformationComputer Lab AccessLearning CommunitiesGraduate School TripsDegree EvaluationsFinancial LiteracyOther
- Certification
  
  As evidence of my signature below, I hereby certify that all of the information I have furnished is correct and true to the best of my knowledge.
  
  Signature and Date:
- Student Signature:*
  
  Clear
- Date:
  
  MonthDayYear
  mm-dd-yyyy
- Please complete only one of the following tabs based on your financial aid dependency status.
- Dependent Student- Under 24 years of age, single, have no children OR children receiving less than half of their support from you.
- Parents' Education Attainment & Income Information
- Student's Name:
  
  First NameLast Name
- Student ID:
- Parent/Guardian's Name:
  
  First NameLast Name
- Did student's mother graduate from college with a 4-year degree?
  
  YesNo
- If Yes, from which university or college:
- Did student's father graduate from college with a 4-year degree?
  
  YesNo
- If Yes, from which university or college:
- Number of people living in parent's household (claimed on taxes)?
- What is parent's most recent taxable income* (not adjusted gross income)?
  Please write in a dollar amount (Not the year taxes were filed)
- * Taxable income is lower than Adjusted Gross Income (AGI) and is listed on all tax forms. Please contact us if you did not or were not required to file a tax form.
  
  All the information on this form is true and complete to the best of my knowledge.
- Parent/Guardian Signature:
  
  Clear
- Date:
  
  MonthDayYear
  mm-dd-yyyy
- Independent Student- Over age 24, married, a veteran or active military, have children who receive more than half of their support from you, OR an orphan or ward of the court.
- Education Attainment & Income Information
- Student's Name:
  
  First NameLast Name
- Student ID:
- Parent/Guardian's Name:
  
  First NameLast Name
- Did your mother graduate from college with a 4-year degree?
  
  YesNo
- If Yes, from which university or college:
- Did your father graduate from college with a 4-year degree?
  
  YesNo
- If Yes, from which university or college:
- Number of people living in your household (claimed on taxes)?
- What is your most recent taxable income* (not adjusted gross income)?
  Please write in a dollar amount (Not the year taxes were filed)
- * Taxable income is lower than Adjusted Gross Income (AGI) and is listed on all tax forms. Please contact us if you did not or were not required to file a tax form.
  
  All the information on this form is true and complete to the best of my knowledge.
- Independent Student's Signature:
  
  Clear
- Date:
  
  MonthDayYear
  mm-dd-yyyy

Student Support Services (SSS) New Student Application

Parents' Education Attainment & Income Information

Education Attainment & Income Information