The University of Alabama
Student Support Services Application

Student Support Services participants must meet federal eligibility requirements. To apply for participation in SSS, please fill out this form completely and submit it.

If a tax return was filed, you must indicate a taxable income amount  in either section A or B. 

All information will be verified through information provided to the Office of Student Financial Aid (FAFSA).

CWID#:  

First Name:    Middle Initial: Last Name: 

Date of Birth:          

Local Mailing Address: 
 
 (Campus Box # or Number, Street, Apt. #)    
 
(City)             (State)        (Zip)
 

Home Mailing Address: 
 
(Number, Street, Apt. #)
 
(City)             (State)        (Zip)
Local Phone:           Cell Phone:
 

Home Phone:           E-mail:

Major:           Classification:


Minor:

Are you a U.S. Citizen? 


Are you a veteran?  
Gender (optional): 
Race/ethnicity (optional):
 
How did you hear about Student Support Services?           
Please tell us if you have participated in other TRiO programs (check all that apply):
  Upward Bound          Talent Search          SSS          McNair Scholar's          EOC

Do you have a disability documented through the Office of Disability Services on the UA campus?          

Are you registered with the Office of Vocational Rehabilitation?           
 
Academic Eligibility Information

High school GPA:  


Highest composite ACT score:

Highest SAT score:    (verbal)           (math)

UA placement in:  MATH 005          MATH 100          EN 099

Previous semester GPA:           Cumulative GPA:

Do you currently have failing grades?   
 
        If yes, in what course(s)? 

Are you a returning adult student (beginning college at 23 or later)?          

Are you majoring in engineering, nursing, math-based business, or pre-medicine?     

Are you in danger of losing a scholarship?           

Other need (defined by SSS) 
PLEASE COMPLETE BOTH QUESTIONS
What services/resources available through SSS are you most interested in receiving?
Please describe your background and/or personal characteristics that illustrate your potential for success in college?

Federal Eligibility Information
To be completed by the student:
Last year, who was/were your primary caregiver(s)?:              
Documentation of First-generation Status 
Must be completed for the parent(s) or legal guardian(s) you most recently lived with:
Mother or legal guardian  
Choose the statement which best describes your educational background:  
Father or legal guardian
Choose the statement which best describes your educational background:

Documentation of Income Status 
For financial aid/income tax purposes, I'm considered a(n)    

If you are a dependent student, complete section A.
If you are an independent student, complete section B.
A.  Dependent Student  To be completed by parent(s) or legal guardian(s):
Last year, the number of family members in this household was

Which federal income tax return did you complete last year?

Enter the taxable income amount found on Form 1040, line 40; Form 1040A line 27; or 
Form 1040EZ, line 6:  $
                                   (Enter N/A if you are an independent student or "0" if you "did not file.")
Go on to parent and student electronic signature.
 
B.  Independent Student  To be completed by the student:
Last year, the number of family members in this household was

Which federal income tax return did you complete last year?

Enter the taxable income amount found on Form 1040, line 40; Form 1040A line 27; or 
Form 1040EZ, line 6:  $(Enter N/A if you are a dependent student)
 
Signature of student:     Date: 
Signature of parent:     Date: 
    (if dependent)

If you are admitted into SSS, you will be asked to sign a printed copy of this application.

For future reference, what is your t-shirt size?

Turn in your application to see if you qualify to join SSS by clicking the Submit Application button below. Please note that spaces are limited.