Application for Services Student Success Services _SSS_ at the by Abbydoc

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									                                                                               Application for Services


Student Success Services (SSS) at the University of Wyoming assists eligible undergraduate students to succeed in college. SSS
Advisors work with participants to develop a unique academic success program tailored to the educational goals of each student.


What does this program offer?
Each student works with a Student Success Services Advisor to develop an Educational Action Plan designed to address academic,
personal, financial, social and career planning needs.

The SSS project can help you in the following ways:

 Provide academic, career and personal guidance                                                 Explore and identify career interests and set career goals
 Arrange tutoring and study groups                                                              Assist with pre- and post-advising
 Clarify university policies and procedures                                                     Support adjustment to campus life
 Assist in setting and attaining ambitious academic goals                                       Maximize financial aid
 Develop studying and test taking skills and strategies                                         Assist with scholarship applications
 Time-management and organizational skills and strategies

Do I qualify?
SSS participants must be working toward completion of their first bachelor’s degree, must be a US citizen or national or meet residency
requirements for federal student financial assistance, AND meet one or more of the following requirements:
 First generation college student: neither parent has received a bachelor’s degree
 Income-eligible: based on current federal guidelines for eligibility (we will help you to determine this)
 Physically or learning disabled: must provide full documentation of disability upon acceptance into SSS. (The SSS program
   provides academic services to students. For disability-related accommodations, we suggest contacting University Disability
   Support Services, 330 Knight Hall, 766-6189.)


How do I apply?
Complete the attached application and return it to Student Success Services, 330 Knight Hall. After your application has been reviewed
to determine eligibility, you will be invited for an intake appointment to determine how this program may best suit your needs.


Still have questions?
Feel free to call, email, or visit us anytime.

330 Knight Hall                                                             Phone: (307) 766-6189
University of Wyoming                                                       Email: sss@uwyo.edu
P.O. Box 3808                                                               Fax: (307) 766-4010
Laramie, WY 82071                                                           TTY: (307) 766-3073

Or, visit our website at www.uwyo.edu/seo/sss The application is available for download at the website.

The University of Wyoming is an affirmative action/equal opportunity employer and institution and does not discriminate on the basis of race, color, religion, sex, national origin, disability,
age, veteran status, sexual orientation, and political belief in any aspect of employment or services. The institution’s educational programs, activities, and services offered to students
and/or employees are administered on a nondiscriminatory basis subject to the provisions of all civil rights laws and statutes. Evidence of practices that are not consistent with this policy
should be reported to the Employment Practices Officer, 766-6721.

                                                                                                                                                                               (Revised 03/09)

                             Student Success Services / 330 Knight Hall / P.O. Box 3808 / 1000 E. University Ave / Laramie, WY 82071
                       Phone: (307) 766-6189 / Fax: (307) 766-4010 / TTY: (307) 766-3073 / Email: sss@uwyo.edu / www.uwyo.edu/seo/sss
Federal TRIO Programs
2008 Annual Low Income Levels


(Effective January 23, 2009 Until Further Notice)

    Size of Family Unit                      48 Contiguous States,                                 Alaska                      Hawaii
                                       D.C., and Outlying Jurisdictions
             1                                          $16,245                                   $20,295                      $18,690
             2                                          $21,855                                   $27,315                      $25,140
             3                                          $27,465                                   $34,335                      $31,590
             4                                          $33,075                                   $41,355                      $38,040
             5                                          $38,685                                   $48,375                      $44,490
             6                                          $44,295                                   $55,395                      $50,940
             7                                          $49,905                                   $62,415                      $57,390
             8                                          $55,515                                   $69,435                      $63,840

For family units with more than eight members, add the following amount for each additional family member:
$5,610 for the 48 contiguous states, the District of Columbia and outlying jurisdictions; $7,020 for Alaska; and
$6,450 for Hawaii.

The term "low-income individual" means an individual whose family's taxable income for the preceding year
did not exceed 150 percent of the poverty level amount.

The figures shown under family income represent amounts equal to 150 percent of the family income levels
established by the Census Bureau for determining poverty status. The poverty guidelines were published by the
U.S. Department of Health and Human Services in the Federal Register, Vol. 74, No. 14, January 23, 2009, pp.
4,199-4,201.




(
                                  You may want to review the eligibility requirements listed on the cover page
                                  prior to completing the application.




                    Student Success Services / 330 Knight Hall / P.O. Box 3808 / 1000 E. University Ave / Laramie, WY 82071
              Phone: (307) 766-6189 / Fax: (307) 766-4010 / TTY: (307) 766-3073 / Email: sss@uwyo.edu / www.uwyo.edu/seo/sss
Applicant: ________________________________________________                           ______ - ______ -_______                ____________________
                 Last Name                   First Nam                 M.I.                  Social Security Number                 W number

Permanent Mailing Address:
                                    Street                                            City                            State         Zip

Laramie Mailing Address:
                                    Street                                            City                            State         Zip

Permanent Phone:                                                               Laramie Phone:
Email Address:                                                                    Work/Alternate Phone:
Date of Birth:                               Current age:                     Gender: M / F
Ethnicity: (We are required to report this information to the US Dept of Education. Your response does not affect eligibility for program services.)
          Check all that apply  Caucasian  Hispanic/Latino  African-American                             Asian
                                          Native Hawaiian/Pacific Islander           Native American/Alaskan Native



Current Class Standing: FR SO JR SR Other:

Have you been accepted to or are you currently enrolled at UW?  Enrolled  Accepted for (term)
__________________________

What was your first college enrollment date at UW or at any other institution if you attended elsewhere? _________________________
Major:                                       Career Plans: ________________________________________________________________
Have you participated in any other TRiO programs:           Yes No If Yes, please specify: _________________________________

Why did you choose to apply to the SSS program?


How can the SSS project assist you? Please check all that apply.

 Advising and educational planning                                       Motivation
 Study skills/strategies                                                 Community resources
 Writing                                                                 Personal counseling
 Academic reading                                                        Choice of major
 Math                                                                    Career planning
 Test-taking skills                                                      Graduate programs
 Working with instructors                                                Financial aid and scholarship information
 Academic policies                                                       Budgeting
 Time-management and organizational skills and strategies
  




 Tutoring (please specify)
_____________________________________________________________________________________

 Other (please specify)

What specific SSS services do you see as being the priority for you at this time?

                        Student Success Services / 330 Knight Hall / P.O. Box 3808 / 1000 E. University Ave / Laramie, WY 82071
                  Phone: (307) 766-6189 / Fax: (307) 766-4010 / TTY: (307) 766-3073 / Email: sss@uwyo.edu / www.uwyo.edu/seo/sss
      Student Success Services / 330 Knight Hall / P.O. Box 3808 / 1000 E. University Ave / Laramie, WY 82071
Phone: (307) 766-6189 / Fax: (307) 766-4010 / TTY: (307) 766-3073 / Email: sss@uwyo.edu / www.uwyo.edu/seo/sss
ELIGIBILITY FOR PROGRAM SERVICES
1. Citizenship/Residency Status:
     Are you a citizen or national of the U.S Yes No / If “No,” do you meet the residency requirements for Federal student
     financial assistance? Yes No (If your answer to both questions is “No,” you are not eligible to join Student Success
     Services. We encourage you to contact our office to see if we can help you locate other academic services programs.)
2. Degree Status:
    Do you currently have a Bachelor’s Degree? Yes No (If your answer is “Yes,” you are not eligible to join Student Success
    Services. We encourage you to contact our office to see if we can help you locate other academic services programs.)
3. First Generation College Student:
     Has your mother completed a Bachelor’s degree or higher? Yes No Unknown
     Has your father completed a Bachelor’s degree or higher? Yes No Unknown
4. Income Eligibility: Please answer the following questions regarding you or your parents’ income for last tax year. Upon acceptance
in the SSS program, you will be required to submit paperwork to verify the information.
    I was claimed on my parents’ income tax return. (If so, go to question 1.)
    I am 24 years of age or older. (If so, go to question 2.)       I am a veteran. (If so, go to question 2.)
    I am married. (If so, go to question 2.)                        I have dependents other than a spouse. (If so, go to question 2.)

   Question 1: What was your parents’ taxable income (NOT GROSS INCOME) on last year’s income tax return? We will require a
   parent signature on an Income Verification Form and/or a copy of their most recent tax return.
   Taxable Income in the preceding tax year: $ ________________                       Receiving a Pell Grant? Yes No
   Question 1b: What is the total number of exemptions claimed on the tax return? ___________


   Question 2: What was your taxable income (NOT GROSS INCOME) on last year’s income tax return? This information is found
   on your tax return. Your signature on this application indicates that this is an accurate statement of taxable income as reported on
   your most recent tax return.
   Taxable Income in the preceding tax year: $ ________________                       Receiving a Pell Grant? Yes No
   Question 2b: What is the total number of exemptions claimed on the tax return? ___________

5. Physical or Learning Disability
    Do you have a physical or learning disability? Yes No If Yes, please specify: ___________________________________
    (Upon acceptance into SSS, you will be required to provide documentation of your disability.)
    Are you enrolled in University Disability Support Services? Yes No
    Would you like more information about this program?         Yes No


I certify that the information on this application is accurate and complete to the best of my knowledge. I hereby authorize the Student Success
Services program to obtain any information from my educational records (e.g., transcripts, entrance test scores, grades, instructor contacts,
etc.) and to perform staffing activities that may be pertinent to my participation in this project. I also agree that, if I am selected to participate in
the SSS project, I will work with my staff advisor to develop and implement an individual Education Action Plan.


    Student Signature                                                                 Date

                         Student Success Services / 330 Knight Hall / P.O. Box 3808 / 1000 E. University Ave / Laramie, WY 82071
                   Phone: (307) 766-6189 / Fax: (307) 766-4010 / TTY: (307) 766-3073 / Email: sss@uwyo.edu / www.uwyo.edu/seo/sss

								
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