• Cameron University Student Support Services (SSS) Membership Application

  • Date of Birth:*
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  • Sex:*
  • Do you own a Computer?*
  • Are you:*
  • Ethnic Background:*
  • Are you a:*
  • Do you believe you might be eligible for SSS by virtue of a disability?*
  • If so, is your disability documented with the CU Disability Services Office?*
  • Do you have a Family Educational Rights and Privacy Act (FERPA) Waiver on file with the University?*
  • Has either of your parents graduated from a four year college?*
  • Are you a:*
    • Financial Statement 

    • SSS is a federally funded TRIO program and is required by the U.S. Department of Education to obtain income information for participants and their parents (if the participant is a dependent).

    • Which of the following best describes you?*
    • Are you receiving any type(s) of financial assistance?*
    • I hereby give Student Support Services my permission to use photographs taken of me for publicity purposes:*

    • This is to certify that the above information is true and correct to the best of my knowledge. Furthermore, I give Student Support Services my permission to receive copies of my educational records and other materials necessary for participation in the Student Support Services Program. I understand all my records will be kept in confidence and in accordance with the Privacy Act of 1974.

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    • Self-Reported Needs Assessment 
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    • Which of the following obstacles will be the most difficult to overcome so you can complete your college degree?*
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