STUDENT SUPPORT SERVICES PROGRAM
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Tutoring Program
First Name/MI
Last Name
If married, list maiden name
Social Security Number
Address #1
Address #2
City
State
Zip
Country
Phone Number
Date of Birth
Current Grade Level
Continuing Freshmen
Sophomore
Junior
Senior
Other
Cumulative GPA
Academic Standing
Good Standing
Not in Good Standing
Re-admit
Transfer
Do you have financial aid or other types of assistance for the school year?
Yes
No
Post Secondary Degree/Certificate Completed:
1 yr certificate/diploma
2 yr certificate/diploma
Associate degree
1st bachelor's degree
2 or more bachelor's degrees
Other
If yes, from what sources. Check all that apply.
Pell Grant/SEOG Grant
Perkins/Stafford Loan
ACAP
TANF
Social Security
ME Voc Rehab
Veteran's Benefits
FAME
Work Study
ASPIRE
Food Stamps
Single Parent
Univ. Grant or Scholarship
ME Student Incentive Scholar
Displaced Homemakers
Umemployment
VA Voc Rehab
Are you now or do you plan to be involved with any UM-Presque or local Community club activities, sports teams or other campus or local community organizations, such as PTA, church groups, town recreation sports teams, aerobic classes, adult education, etc.
If yes, please list all that apply:
Please list services that you are requesting
Please list the e-mail address you are currently using:
You will be required to sign a Release of Information and Contract form when you have your appointment with Student Support Services.