East Central University-SSS-Application Form

East Central University

Student Support Services
East Central University
Student Support Services
1100 E. 14th St.

Administration Bldg. 250
Ada, OK 74820

Thank you for your interest in our Student Support Services program! Please complete this application as thoroughly as possible. You cannot save and restart this application. You may want to review the included items, take some time to make notes and gather the required documents, and then return to submit your application. If you have any questions, please call our office at (580) 559-5833.
General Information:
Name*

First NameMiddle NameLast Name
Student ID Number:
Date of Birth:

MonthDayYear
mm-dd-yyyy
Gender
Marital Status
Local Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number
(999)999-9999
ECU Email Address*
example@example.com
Where or from whom did you hear about this program?
Ethnicity:
Are you of Hispanic descent?
Race (Mark all that apply):
American Indian or Alaskan Native
Asian
Black or African American
Hawaiian or other Native to Pacific Island
White
Eligibility:
Are you a U.S. Citizen or permanent resident?
Have either of your parents completed a four year bachelor's degree?
Do you have a documented disability?
Have you submitted your FAFSA application?
Educational Information:
Intended Major/Career
Are you registered for classes?
What is your educational goal? (mark all that apply):

Bachelor's degreeMaster's DegreeDoctoral Degree
ACT Composite Score
High School Attended:
Diploma Date:

MonthDayYear
mm-dd-yyyy
What College(s) have you previously attended?
Are all transcripts on file at ECU?
How many hours of college credit have you earned?
What degree or certificate have you received?
Need for Services:
What do you see as your biggest challenge(s) or potential obstacle(s) this semester/year?
What specifically would you expect our office to assist you with in order for you to achieve your goals?
Services Available:
Please check all SSS program services that you are interested in:

Academic AdvismentUndecided Major/CareerAssessmentTutoring ServicesFinancial Aid AssistanceCulturally Enriching ExperiencesFinancial/Economic LiteracyGraduate School PreparationPersonal Counseling
Income Verification:
As a federally funded TRIO program, Student Support Services is required to provide documentation of a Student's eligibility for the program to the U.S. Department of Education and implement the TRIO Regulations that state twothirds of the students served must meet federal low-income guidelines.

All applicants must complete this section whether or not you believe you qualify as low-income. Verification requirements for TRIO vary depending on whether students are independent or dependent.

To determine whether you are a DEPENDENT or an INDEPENDENT student, please answer the following:
Were you at least 24 years old by December 31st?
Are you a veteran of the U.S. Armed Forces?
Are you married?
Are you an orphan or a ward of the court, or were you a ward of the court until age 18?
Do you have any legal dependents (other than a spouse),such as children or parents who get more than 1/2 their support from you?
If you answered NO to every question, you are considered DEPENDENT. Please upload one of the following:
- A signed copy of your Parent(s) or guardian(s) most recent Federal Income Tax Return, OR
- A copy of the current year Student Aid Report (SAR) which can be found by logging into studentaid.gov using your FSA ID and selecting the View or Print your Student Aid Report (SAR) option [see NOTE below], OR
- A document with the statement: "I certify that my parent's TAXABLE INCOME from all sources in the most recent tax year was $_________ with a family size of ____ (include your parents and their dependents). By signing this document, I attest under penalty of perjury that the above statement is true and correct." signed/dated by you AND your parent. (The Taxable Income Information can be found on the IRS 1040 form line 15.)
If you answered YES to any question, you are considered INDEPENDENT. Please upload one of the following:
- A signed copy of your most recent Federal Income Tax Return, OR
- A copy of the current year Student Aid Report (SAR) which can be found by logging into studentaid.gov using your FSA ID and selecting the View or Print your Student Aid Report (SAR) option [see NOTE below], OR
  A document with the statement: "I certify that my TAXABLE INCOME from all
- sources in the most recent tax year was $_________ with a family size of ____ (include yourself, spouse, and dependents). By signing this document, I attest under penalty of perjury that the above statement is true and correct." signed/dated by you. (The Taxable Income Information can be found on the IRS 1040 form line 15.)
NOTE Regarding SAR: If you used the Data Retrieval Tool (DRT) to transfer any IRS tax information, your Student Aid Report (SAR) cannot be used for income verification.

Questions with the transferred IRS tax information are marked as "Transferred from the IRS."
Upload your Income Verification document(s) here:

Cancelof
Income
Family Size
By signing below, I authorize the Student Support Services program to obtain, copy, review, and discuss education records and other materials necessary for participation in a Student Support Services program.

I understand that the Student Support Services program reserves the right to admit or deny any student enrollment in a Student Support Services program. Completion of the application does not guarantee acceptance into the program. I
also certify that all of the above information is true and correct to the best of my knowledge. I give the Student Support Services program permission to use my statements, images, voices, or combination of these in promotional items (i.e.
brochures, web sites, etc.) Furthermore, I understand that further documentation of income may be needed and all my records will be kept in confidence in accordance with the Federal Education Rights and Privacy Act (FERPA), codified
at 20 USC 1232g.

I verify that I am at least 18 years of age, I have read this realize and fully familiar with the contents.

Sign and Submit:
Applicant's Signature

SimpleSMS/TextStudent E-mail
Signature

Clear
Date

MonthDayYear
Date

East Central University

General Information:

Ethnicity:

Eligibility:

Educational Information:

Need for Services:

Services Available:

Income Verification: