Fillable Southern University at Shreveport Student Support Services Application (Southern University at Shreveport)

Fill Online, Printable, Fillable, Blank Southern University at Shreveport Student Support Services Application (Southern University at Shreveport) Form

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

Southern University at Shreveport Student Support Services Application (Southern University at Shreveport)

On average this form takes 16 minutes to complete

The Southern University at Shreveport Student Support Services Application (Southern University at Shreveport) form is 2 pages long and contains:

  • 1 signature
  • 72 check-boxes
  • 28 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Southern University at Shreveport

BROWSE SOUTHERN UNIVERSITY AT SHREVEPORT 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
 
Revised 8/30/2019
Form-300M
Southern University at Shreveport
Student Support Services Application
Fine Arts Building C-15 (318) 670-9306 or (318) 670-9325
All information submitted is strictly confidential and will be used for the purposes intended by authorized Southern
University staff.
Release of Information:
I hereby authorized the Student Support Services staff to obtain my records or data pertinent to my participation in the program
from the Admissions Office, Registrar’s Office, and Financial Aid Office. I also authorize the college, or a professional
associated with it, to access and release data for purposes of my academic success. I understand that if I am receiving tutoring or
peer counseling, my tutor or peer counselor or SSS staff will contact my instructor(s) as needed to better assist me in the subject
in which I am being tutored. I understand this authorization may be revoked by me at any time through written or verbal
communication.
Last Name First Name Middle
Street Address Apt# City State Zip
Alternate Address Apt# City State Zip
SSN ________________________________________________________________________
DOB ________________________________________________________________________
Gender Male Female
Home Phone ________________________________________________________________________
Work Phone ________________________________________________________________________
Contact Number ________________________________________________________________________
Facebook and/or Twitter ________________________________________________________________________
Email address (that is checked
regularly) ________________________________________________________________________
Name of High School attended: ___________________________________________________________________
Diploma
GED
Year diploma/GED
Rec’d
High School GPA:
Eligibility Criteria
1. What is your marital status? Single Divorced Married Widowed Separated
2. Has either parent graduated from a 4-year university? Yes No
3. Are you receiving financial aid? Yes No
4. Are you a Louisiana resident? Yes No
5. Are you active military? Yes No If yes, what branch? __________________
6. Are you a Veteran? Yes No If yes do you receive veteran benefits? Yes No
7. What is your work status? Full Time Part Time Unemployed
Revised 8/30/2019
Form-300M
8. Are you a United States citizen? Yes No If No, what is your status? ________________________
Ethnic Group Age Group Household Income
Black under 20 under $10,000
White 20-30 $10, 000-$20,000
Hispanic 31-40 $20,000-$30,000
Asian American 41-50 $30,000-$40,000
American Indian 51-60 $40,000-$50,000
Biracial/Multiracial over 61 over $50,000
Other
Academic Planning Total in Household (Include Self)
1
What is your academic classification? 2
First Year, never attended college? 3
Freshman 4
Sophomore 5
Special Student If more than 5, ___________
What is your enrollment status?
Full Time
Part Time
Special
What is your intended major? _______________________________________________
Academic Plan: Associate Degree and Transfer to 4-year institution or
Associate Degree and no further education/seek employment
Certificate Program
1. If you plan to transfer, which institution will you attend? _____________________________
2. Did you transfer to SUSLA from another college or university? Yes No
3. Have you participated in any previous TRIO programs?
Yes No Talent Search
Yes No Educational Opportunity Center
Yes No Upward Bound
Yes No Student Support Services
Services Offered
Please check all services that you are interested in receiving by participating in this program:
Academic Counseling Personal Counseling
Career Planning Study Skills Workshops
Academic Tutoring Survival Seminars (How To’s)
Supplemental Instruction Transfer/Graduation Assistance
Social/Cultural Activities
Financial Literacy
Emergency Contact
Name: _________________________________ Relationship______________________________
Address: (City, State, Zip)__________________________________________________________
Phone: __________________________________Alternate Phone:__________________________
I certify that all information submitted above is true to the best of my knowledge and that SSS has my permission to verify the information
submitted. I understand that this information will be used for educational/institutional purposes deemed appropriate by Student Support Services.
Signature ____________________________________ Date ________________________________________
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

Southern University at Shreveport Student Support Services Application (Southern University at Shreveport)

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 17 September 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document