319704-California Lutheran University-SSS-2025 Summer Application-Gavin

California Lutheran University-SSS
Thank you for your interest in applying to Student Support Services (SSS) at California Lutheran University. SSS is a federally funded program at Cal Lutheran that works with students who are first-generation, income-qualified and students served by the Disability Support Services office. We commend you for taking this step in your education.

SSS applications must be complete before a student can be considered for admission to the program. All information provided will be kept confidential.

Please contact the SSS office if you have any questions: clusss@callutheran.edu or (805)493-3535.

Thank you,

SSS Staff

Applicant Information
Name*

FirstM.I.Last
Social Security Number
999-99-9999
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number
(999)999-9999
Cal Lutheran Student ID Number
Email*
example@example.com
Ethnicity(please mark all that apply)

American Indian/Alaskan NativeAsianBlack/African AmericanHawaiian/Pacific IslanderHispanic/LatinoWhite
Gender

FemaleMaleNon-binary/Other/NA
Preferred Name
Personal Pronouns

He/Him/HisShe/Her/HersThey/Them/TheirsOther
Date of Birth

MonthDayYear
Date of Birth
Major/Minor
Class Standing:

First-YearSophomoreJuniorSenior
Transfer Student

YesNo
Have you been involved with any of the following educational equity programs?

Talent SearchUpward BoundMath/Science Upward BoundStudent Support ServicesEOP/EOPSGear UpAVIDOther

Program Eligibility
Citizenship:

U.S. CitizenPermanent ResidentDreamerOther
Parent 1 Highest level of education

No Formal  EducationElementary  (Grade K-6)Junior High (Grade 7-8)High School (Grade 9-12)Community College (2yr. degree)College Degree (4yr. degree)Master's Degree or HigherNon Applicable, Please Explain
Parent 2 Highest level of education

No Formal  EducationElementary  (Grade K-6)Junior High (Grade 7-8)High School (Grade 9-12)Community College (2yr. degree)College Degree (4yr. degree)Master's Degree or HigherNon Applicable, Please Explain
Do you have a physical/learning disability, or an illness that might require accommodative services with Disability Support Services?

YesNo
Please list the total number of people (including you) in your household:
If Dependent
*A dependent student is one that included parent information on their FAFSA.
Did your parents file a tax return in the 2022 federal income tax year?

YesNo, but intend to fileNo, were not required
Please indicate your parents' 2022 TaxableIncome (not Adjusted Gross Income) For taxable income, please see tax return -1040; line 6
If Independent
*An independent student is at least one of the following: 24 years or older, married, a veteran, a member of the armed forces, an orphan, a ward of the court or someone with legal dependents other than a spouse.
Did you file a tax return in the 2022 federal income tax year?

YesNo, but intend to fileNo, were not required
Please indicate your 2021 Taxable Income (not Adjusted Gross Income) For taxable income, please see tax return - 1040; line 6:

SOAR Into Telios
SOAR Into Telios will be a residential program that will run Sunday, July 27th-Friday, August 1st.
Are you interested in attending SOAR into Telios 2025?

YesNo
Dietary Restrictions:
Can you commit to living on campus from July 27th-August 1st?

YesNo
What is your t-shirt size?

Personal Video Statement
Please create a short video. In your video, introduce yourself, tell us a little about you,
and tell us why college is important to you.You can submit your video to:
clusss@callutheran.edu

(Please be sure to include your name & ID number with your response). If you are unable to make a recording, please submit a written statement sharing why college is important to you.

Acknowledgement/Consent
I understand that if selected as a SSS participant, the personal information provided will be protected by the Family Educational Acts and Privacy Act (FERPA), and will be kept Confidential.

I authorize the release of my financial aid information, including but not limited to, FAFSA data, Aid Offer information to representatives of the Cal Lutheran SSS Program for the specific purpose of determining my eligibility for additional support programs.

And if accepted and for continued program participation, I authorize California Lutheran University SSS Program to receive copy of transcripts, grade reports, verify services are received by Cal Lutheran’s Disability Support Services Program, and other records necessary for application review. If I attend SOAR into Telios, I commit to staying on campus for the week of July 27th-August 1st.

Upon admission to the SSS program, I recognize that I will be required to fully participate in the program as well as attend a Student Success Plan every semester which will be further explained during the initial Intake Meeting.

In addition, I hereby give permission for my name, photograph, work and/or statements to be used by SSS for promotional, publicity and/or instructional purposes.
Initial
Applicant Signature

Clear
Date

MonthDayYear
Date
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date

Please verify that you are human*
Should be Empty: