SSS Regular Application

First Name *

Last Name *

Preferred Name *

Classification *

Freshman (0-29 hrs.)

Sophomore (30-59 hrs.)

Junior (60-89 hrs.)

Senior (+90 hrs.)

Graduate Student or Pursuing 2nd Bachelor's Degree

ULID *

ex. C001234567

Street Address *

City *

State *

Zip Code *

Home Phone # *

Cell Phone # *

Date of Birth *

Month

Day

Year

Marital Status *

Gender *

Race/Etnicity *

To select more than one, hold shift as you select.

Are you a U.S. citizen? *

Are you a U.S. military veteran? *

Do you have a documented disability? *

What is your college major? *

What is your COLLEGE Cumulative GPA? (If No College GPA is Available, Input 0.0) *

Please check all the free services you need (must check at least one). *

To select more than one, hold shift as you select.

What is your Parent/Guardian One's full name? *

What is your Parent/Guardian's Two full name? *

Which parent(s) did you live with? *

Did either parent/guardian receive a bachelor's (4 year) degree? *

Select the highest level of education completed for Parent/Guardian One *

Select the highest level of education completed for Parent/Guardian Two *

High School Attended *

High School GPA *

Did you participate in the Talent Search program while in high school? *

Did you participate in the Upward Bound program while in high school? *

Did you participate in the Gear Up program while in high school? *

Are you a participant of the Louisiana Educate Program (LEP)? *

First semester/year you enrolled or will enroll at UL? *

How did you hear about SSS? *

Please enter department *

Please enter other *

I give SSS permission to have access to financial information as reported on FAFSA.

Yes

No

Please type your name to be used as your signature. *

University of Louisiana at Lafayette

Department of Special Services

University College

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