Saginaw Valley State University-SSS-Application Form

Saginaw Valley State University-SSS-Application Form
Student Information
Name:*

First NameLast Name
Student ID # (SVSU):*
Phone:*
(999)999-9999
SVSU Email address:*
example@example.com
Personal Email Address:
example@example.com
Local/School Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Permanent Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birthdate:*

MonthDayYear
mm-dd-yyyy
Sex:

FemaleMale
Are you a U.S. Citizen or Permanent Resident?*

NoYes
Ethnicity: ethnicity is broken out in two categories, (Hispanic or Latino) or (Not Hispanic or Latino)
- Hispanic or Latino - A person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.
Ethnicity:*

Hispanic or LatinoNot Hispanic or Latino
Race:*

American Indian/Alaskan NativeAsianWhiteBlack or African AmericanNative Hawaiian or Other Pacific IslanderOther not listed (please specify)
Marital Status:

MarriedSingleSeparatedDivorcedWidowed
Do you have any dependents?

NoYes
Were you ever a part of the foster care system or deemed a ward of the court?*

NoYes
Is English your second language?*

NoYes
Are you a veteran?

NoYes
Have you participated in a TRIO program previously?

NoYes
If Yes, what program?
How did you hear about us?
Academic Need
Education Level (check all that apply)*

I was a part of a Dual enrollment Highschool/College program.I am a High School/ GED GraduateI am a transfer studentI am an incoming SVSU student.I am currently enrolled at SVSU
What school did you transfer from?
Planned enrollment:

I will be enrolled in at least 12 credits (Full time)I will be enrolled in 11 credits or less (Part time)
Current enrollment

I am enrolled in at least 12 credits (Full time)I am enrolled in 11 credits or less (Part time)
What is your current Grade Point Average?
Areas in which you feel trio staff may be able to assist you with: (check all that apply)*

Low GradesAcademic Preparedness for college level workEducational and/or career goalsLimited English proficiencyNeed for academic support to raise gradesStudy Skills/Time Management AssistanceTutoring and Academic SupportMotivational and Personal CounselingSecondary Program Admission AssistanceGraduate School CounselingCareer CounselingBeen out of the academic pipeline for 5 or more years.
What is your intended field of study/major?
Eligibility Status
Are you a First-Generation college student?*

NoYes
A student is considered first generation when neither parent/guardian has received a bachelor’s degree
Do you have a documented physical, mental, or learning disability?*

NoYes
Based on information from the most recent tax year. * (Please mark the appropriate box below)*

I was an independent student (typically age 24 or older, married or emancipated; parental income is not reported on the FAFSA)I was a dependent student (younger than 24, unmarried or not emancipated; parental income is reported on the FAFSA)
Did you complete the FAFSA for the last academic year:*

NoYes
Please list your AGI from last years' FAFSA?
How many members were in your household?
Did you complete the FAFSA for the current academic year:*

NoYes
Please list your AGI from your current years' FAFSA?
How many members were in your household?
Essay Questions
Extra Curricular Activity
Please share no more than three extracurricular activities including those that demonstrate leadership or service on behalf of historically underprivileged populations. Include major accomplishments, including musical instrument played, etc.
Please describe your career goals.*
What do you see as your greatest challenges in achieving success at SVSU and what are your strengths and resources that you will utilize to overcome these challenges? *
STUDENT AUTHORIZATION AND RELEASE I certify that all the information on this form is true and complete to the best of my knowledge. I authorize the SSS Project to obtain and review any academic, financial, disability or demographic information or documentation from staff and college instructors needed for the purposes of data collection and reporting, or progress monitoring, both at the time of my application and throughout my participation in the program.

I am also aware that the personal information that is provided to the Student Support Services Program will be protected under the Family Education Rights Privacy Act of 1974.
Student Signature:

Clear
Date Student Signed

MonthDayYear
mm-dd-yyyy

Saginaw Valley State University-SSS-Application Form

Student Information

Academic Need

Eligibility Status

Essay Questions