STUDENT SUPPORT SERVICES PROGRAM
Student Application Form
Return to TRIO SSS Home Page
Tutoring Program
First Name/MI
Last Name
Social Security Number
Address #1
Address #2
City
State
Zip
Country
Phone Number
Date of Birth
Taxable Income is Under:
$14,355.
$19,245.
$24,135.
$29,025.
$33,915.
$38,805.
$43,695.
$48,585.
Proof of Income
I will provide a copy of my income statement at appointment
I will be providing income within 10 days
I was not required to file income taxes for 2002
Student Support Services may contact Financial Aid regarding my income
Ethnic Background
American Indian
Asian
African American
Hispanic
White
Pacific Islander
Franco-American
Other
Are you a US Citizen?
Yes
No
Parent's Education
Yes, either parent had B.S./B.A. before I was 18.
No, neither parent received a degree.
Gender
Male
Female
Do you have a disability
Yes
No
If yes, please identify disability
Mental or Physical Disabilities, including learning disabilities
Have you ever particpated in:
Upward Bound (UB)
Talent Search (TS)
ME Ed Oppty Ctr (MEOC)
None of the above
High School Attended
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 married, what was your previous last name?
Do you have financial aid or other types of assistance for the school year?
Yes
No
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.
