College Connect Locations
SUNO Campus: Miguel Devezin
Bashful Admin. Bldg, Rm 210
Phone: 504-286-5007
Fax: 504-286-5213
Email: [email protected]
SUBR Campus: Carey Williams
Stewart Hall, Rm 107
Phone: 225-771-5630
Fax: 225-714-9540
Email: [email protected]
Office of Student Financial Aid & Scholarships
L.C. Barnes Administration Bldg, Rm A-43
3050 Martin Luther King, Jr. Drive Shreveport, La 71107
Phone: (318) 670-9221 Fax: (318) 670-6313 Email: [email protected]
2016-2017 Student Institutional Data Form
PLEASE PRINT THE INFORMATION BELOW:
Name: ________________________________________________________________________________________________________
9000
Banner Student ID Number:_______________________________________________________________________
Street Address: _____________________________________________________________________________________________
City, State, Zip: _____________________________________________________________________________________________
Home Number: _______________________________ Cell Number: ___________________________________________
Email Address: __________________________________________________ Major:__________________________________
Are you an employee of SUSLA?
Yes
No
Are you a relative of a SUSLA employee?
Yes
No
List the names of any university/college that you have attended prior to attending SUSLA
University/College
City
State
Year
1.
2.
3.
4.
**Do you plan to attend Summer I
, Summer II , Summer III
?**
STUDENT CERTIFICATION
I certify that the information reported on my Free Application for Federal Student Aid and this form is accurate to the best of
my knowledge. If asked by an authorized official, I agree to give proof of the information reported on these applications. I
understand that if I do not provide proof when requested, I may not receive financial aid. I have read the Financial Aid
Satisfactory Academic Progress Policy and Refund Policies on the SUSLA website.
**RETURN OF TITLE IV FUNDS POLICY**
The Department of Education requires that all students complete 60% of the semester that they are enrolled in. If you
are considering WITHDRAWAL, please understand that the Return of Title IV Policy will go into effect. This means that if a
student withdraws prior to the 60% mark, the student MAY be responsible for paying PART or ALL of the financial aid received
back to the financial aid program from which it was disbursed.
**STATEMENT OF EDUCATIONAL PURPOSE**
I will use ALL Title IV money received only for expenses related to my study at Southern University at Shreveport.
Student Class Schedule
Subject/Course #
Course Title
Time/Day
_____________________________________________________________________________________
Student’s Signature
Credit Hours
Instructor
________________________________________
Date
____________________________________________________
__________________________
Financial Aid Advisor’s Signature
Date
Southern University at Shreveport does not discriminate on the basis of race, color, national origin, gender, age or disability. Title IX Coordinator: Ms. Tilisha T. Revised
03/2016
Bryant, Administration Building, Room A-43, (318) 670-9210. Section 504 Coordinator: Ms. Jerushka Ellis, Fine Arts Building, Room C04 D, (318) 670-9473.