Student Support Services Screening Application

Student Support Services Screening Application

Date:

Student ID:

Semester:

Name:

Phone Number:

Address:

City:

State:

Zip:

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 re turning to SUSLA next semester?

Please check all services that you are interested in receiving by participating in this program.