SSS Regular Application

First Name *

Last 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? *

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 Father's full name? *

What is your Mother's full name? *

Which parent(s) did you live with? *

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

What month/year did your father earn his 4 year degree? *

Enter as MM/YYYY; If no degree was earned enter N/A

What month/year did you mother earn her 4 year degree? *

Enter as MM/YYYY; If no degree was earned enter N/A

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 at UL *

How did you hear about SSS? *

Please enter department *

Please enter other *

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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