SSS - Health Sciences

SSS - Health Sciences Application

Please fill out the following form:

* Sex:
* Ethnicity:
* Race:
* Check here if you were previously enrolled in Student Support Services (SSS).
* Are you currently enrolled this semester at Amarillo College?
* Are you a U.S. Citizen?
If not, are you a permanent resident of the U.S.?
Are you here on a student visa?

* Income verification will be required (either a signed/dated FAFSA or signed/dated tax return)

Do you currently file your income taxes independently or do your parent(s) / spouse claim you as a dependent?
If you are claimed as a dependent, who currently claims you?

* per
* Have you filled out a FAFSA for the current year?
* Are you employed?
If not, do you plan to work soon (within the next few months)?
How many hours per week do you work?
* Are you currently receiving financial aid?
* Have either of your parents/guardians received a 4-year college degree?

Birth/Adoptive Mother
* Birth/Adoptive Father
* Do you have a physical or learning disability?
Is your disability documented in the disAbility Services Office at Amarillo College?
* How did you learn about the SSS Health Sciences Program at AC?

Please mark ALL that apply to you:

Please mark the services you would be interested in receiving (check each one of interest)
If not a high school graduate, do you have a GED?
* Career Plans

What are your plans after completing your current degree (choose all that apply)?

* All information on this application is true and correct to the best of my knowledge.

I authorize SSS Health Sciences staff to verify information I have provided to qualify for the SSS Health Sciences program and to gather any other information or data needed (such as grades, financial information)to extend program services.

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