SSS - Health Sciences Application

Please fill out the following form:

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* Sex:


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* 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?


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* 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?


* 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)




























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If not a high school graduate, do you have a GED?



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* Career Plans

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








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* 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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