Fillable SSS App (Haskell Indian Nations University)

Fill Online, Printable, Fillable, Blank SSS App (Haskell Indian Nations University) Form

Use Fill to complete blank online HASKELL INDIAN NATIONS UNIVERSITY pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

SSS App (Haskell Indian Nations University)

On average this form takes 18 minutes to complete

The SSS App (Haskell Indian Nations University) form is 2 pages long and contains:

  • 2 signatures
  • 64 check-boxes
  • 34 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Haskell Indian Nations University

BROWSE HASKELL INDIAN NATIONS UNIVERSITY FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
All i
nformation provided will remain confidential and used only for: a.) Eligibility determination, b.) Student demographics, c.)
record keeping, d.) needs assessment, e.) federal reporting, f.) other administrative purposes
Date: _____________________ Current Semester: _______________________ Year: 20______
Student Status: ______New Freshmen ______Re-Admitted ______Transfer ______Continuing
PERSONAL INFORMATION:
Name: _________________________________________________ DOB: ________________ Age: ______________
(maiden)
Gender: _____ SS# _________________ Tribal Affiliation: ________________________ U.S. Citizen: Yes No
Permanent Address:
*Home address (city) (state) (zip)
Off-Campus Address:_____________________________________________________ Marital Status: Single/Married
(city) (state) (zip)
Phone Num
ber: (_______)_____________________ Email Address: _______________________________________
On-Campus Information: Dorm _________________________Rm. #___________ Haskell Box #________
Participation in other TRiO programs: (check all that apply & give approximate date)
____Talent Search ___Upward Bound ___SSS ___McNair Scholars
When:______________________________________________________________________
EDUCATION:
Degrees & Diplomas Held: (Check all that apply)
GED HS Diploma-Yr.______ Associate’s Degree BA, BFA, BS, BGS Master’s or Doctorate
Other: ___________________________
Haskell Classification: Freshman Sophomore Junior Senior GPA: __________
Major: _______________________Have you applied for acceptance into this Haskell program? Y N
ELIGIBILITY:
Income Status:
Are you receiving financial aid (i.e. PELL, etc) through the Haskell Financial Aid Office?
____YES
____ NO If no, why not? ___ Financial Reasons ___ Academic Reasons ___ did not apply for FAFSA
____UNSURE If unsure, why? ___Waiting for FAFSA results ___Need Assistance finding out
What is your Family Income per year? $ ____________ Family Size _______
First-Generation College Status:
Has your mother completed a bachelor’s degree or beyond? Y N Unknown
Has your father completed a bachelor’s degree or beyond? Y N Unknown
Or has your guardian completed a bachelor’s degree or beyond? Y N Unknown
Were you living with your mother prior to your 18
th
birthday? Y N
Were you living with your father prior to your 18
th
birthday? Y N
Were you living with your guardian prior to your 18
th
birthday? Y N
APPLICATION
TRiO-Student Support Services
Haskell Indian Nations University
155 Indian Ave, Lawrence, KS 66046
Phone: (785)830-2727 Email: mspoonhunter@haskell.edu
[1]
Disability Status:
Do you have a disability? Y N
If so, is documentation regarding your disability filed with the university? Y N
*The disability coordinator is located in Tommaney Hall, room 132 (computer lab).
ACADEMIC NEED: (Choose one that best describes WHY you seek our academic services)
1.) Low
H.S. grades ____ 7.) Out of the academic pipeline for 5+ years ____
2.) Low Admission scores ____ 8.) Limited English proficiency ____
3.) Predictive Indicator ____ 9.) Lack of educational/Career goals ____
4.) Diagnostic tests ____ 10.) Lack of preparedness ____
5.) Low college grades ____ 11.) Need to raise grades ____
6.) H.S. equivalency ____ 12.) Other: ___________________ ____
Veri
fication of Accuracy: To the best of my knowledge, the above information is true and accurate. Initials________
Statement of Agreement & Consent: I authorize Haskell Student Support Services to gather my ACT scores, financial aid reports,
transcripts, and other necessary information, which will provide me with the services that I have requested. I understand that the
collected data, plus information I provide on this form, will be used to make reports to the US Department of Education for the re-
funding of this program. I also authorize SSS to obtain periodic reports from my instructors regarding my academic progress for
courses in which I am enrolled. I understand that all information will be kept confidential and will be used for the purposes specified.
My failure to adhere to the SSS policies is possible dismissal from the SSS program.
Student Signature: ___________________________________________________ Date: ___________________
OFFICE USE ONLY: (please check) STATUS:
____ LI ____FG ____LI/FG ____Eligibility Not Met ____Accepted
____Pending (need more info.)
____ Wait List
SSS Signature: ______________________________________________________ Date: ___________________
[2]
ELIGIBILITY Continued:
click to sign
signature
click to edit
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

SSS App (Haskell Indian Nations University)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 27 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document