Ethnic Origin: (Select at least ONE that applies)
Are you a transfer student?
Are you a veteran of the United States Armed Forces?
Are you a ward of the court or homeless?
Are you currently employed?
Are you currently on academic probation?
Have you ever been on academic suspension from OLLU?
Are you registered for any intensive courses (Math 1301 INT, MATH 1304 INT or ENGL 1313 INT)?
If you selected other, please attach a copy of your Permanent Resident Card to part 6.
Referred to Student Support Services by:
Please select if you have ever been a participant in any of the following TRiO programs:
Expected date of graduation:
Explain in detail your plans after graduation (Graduate School, Employement, Career goals/ aspirations, additional degrees you would like to attain, etc.)
Why are you interested in being a Student Support Services participant?
What classes/ subjects do you like or feel best about? Why?
What classes/ subjects do you find difficult or concern you most? Why?
Are you involved in any extracurricular activities? Please List.
How can Student Support Services help you complete your degree? (Please check all that apply.)
Educational Motivational/Academic Concerns
(Check all that apply.)
Highest Education Level of Your Mother:
Highest Education Level of Your Father:
Which type of financial aid are you receiving for the current year?
(Please check all that apply.)
Do your parents claim you as an exemption on their income tax return?
Total number of people in family household:
Please indicated your family's Annual Taxable* Income:
(*Please note that you can find the Annual Taxable Income from last year's tax return on: Line 43 - Form 1040; Line 27 - Form 1040A; Line 6 - Form 1040EZ. Do not use the amount listed for Adjusted Gross Income on your income tax form. NOTE: Additional documentation will be required).
Do you have a documented disability?:
If yes, what type of disability do you have?
Is your documentation on file with:
(If you have a documented disability but have not yet filed your documentation with either of these offices, you will need to do so before we can verify your eligibility for services based on this requirement.)