|
Thank you for your interest in our Student Support Services program! Please complete this application as thoroughly as possible. You cannot save and restart this application. If you have any questions, please email ambers@shawneecc.edu.
|
|
Biographical Information:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Are you a United States Citizen or Permanent Resident?
|
Non-citizen's Visa Number (if applicable)
|
Race Classification (for statistical purposes only)
*
|
Are you Hispanic or Latino?
*
|
Do you have a documented disability?
|
Have you submitted documentation of your disability to the Accessibility & Resource Services at Shawnee Community College?
|
|
|
High School Graduation Year (if applicable)
|
GED Completion Year (if applicable)
|
Parents Educational Level:
|
Which do you plan to complete at Shawnee Community College
|
|
Have you already completed a 2-year or 4-year degree?
|
|
|
|
CERTIFICATION and RELEASE OF INFORMATION:
The information on this form is confidential and will help determine eligibility for SSS. I declare that the information given here is true and correct to the best of my knowledge. I authorize Student Support Services access to my student records, including academic records and financial awards and any other information pertaining to my enrollment in SSS. Additionally, if I transfer to another institution, I authorize SSS to contact said institution and/or the National Student Clearinghouse for follow-up information.
|
Click here to start signing.
|
DO NOT FORGET TO HIT "SUBMIT APPLICATION" BELOW
|
Office Use Only:
Advisor Signature: _______________________________________________ Date: __________
Director Signature: _______________________________________________ Date: ___________
FG ______ LI _____ D _____ FG/LI _____ D/LI _____
Acceptance Date: _____________ Semester _______
1st year never attended ____ 1st year attended before (below 30 hours) ____ 2nd year ____
Current Cumulative GPA _________ Dual Credit/Escrow? Y N
|
|