Student Support Services
Screening Application
Date:_____________ ID/SS#: _____________________________ Semester: ____________
Name: _______________________________________ Phone: ________________________
Address: ___________________________________________________________________
Street
City
Are you currently receiving financial aid?
If not, have you applied for financial aid?
Has either parent graduated from 4-year college?
Will you be returning to SUSLA next semester?
State
Yes
Yes
Yes
Yes
Zip
No
No
No
No
Please check all services that you are interested in receiving by participating in this program.
Academic Counseling
Career Planning
Academic Tutoring
Supplemental Instruction
Social/Cultural Activities
Financial Literacy
Personal Counseling
Study Skills Workshops
Survival Seminars (How To’s)
Transfer/Graduation Assistance
Technological Assistance
Student Support Services
Screening Application
Date:_____________ ID/SS#: _____________________________ Semester: ____________
Name: _______________________________________ Phone: _____________________
Address: ___________________________________________________________________
Street
City
Are you currently receiving financial aid?
If not, have you applied for financial aid?
Has either parent graduated from 4-year college?
Will you be returning to SUSLA next semester?
State
Yes
Yes
Yes
Yes
Zip
No
No
No
No
Please check all services that you are interested in receiving by participating in this program.
Academic Counseling
Career Planning
Academic Tutoring
Supplemental Instruction
Social/Cultural Activities
Financial Literacy
Personal Counseling
Study Skills Workshops
Survival Seminars (How To’s)
Transfer/Graduation Assistance
Technological Assistance