A federally funded TRIO program at Arkansas Tech University  - Ozark Campus
*TRIO SSS serves students who are seeking a Technical Certificate or Associate Degree
 
Thank you for your interest in our Student Support Services program. Please complete this application as thoroughly as possible.  You cannot save and restart this application. 
 

General Information:

 
Last Name *
First Name *
Middle Name *
Preferred Name
Tnumber *
Date of Birth *
Tech Email *
Phone *
Can this phone receive text messages? *
Mailing Address *
City *
State *
Zip *
Gender *

Race and Ethnicity: Please choose ALL that apply:

 
Hispanic/Latino *
American Indian or Alaskan Native *
Asian *
Black or African American *
Hawaiian or other Native to Pacific Island *
White *

Academic Information:

 
Education *
Year Graduated *
Major *
Are you considering a 4-year (Bachelor) degree *

 Academic need: check all that apply, must check at least 1:

 
Low High School Grades
Low Admissions Test (ACT, ACCUPLACER)
Low College Grades
Falling Grades
Out of school more than 5 years
Limited English Proficiency
Lack of educational/career goals
Lack of academic preparedness
Need for academic support to raise grades
Other

Check the services which are of greatest need(must check at least one):

 
Tutoring
Study Skills
Computer Lab/Technology
Financial Aid Information
Career Advising
Academic Advising
Mentoring/Counseling
Leadership Skills
Cultural Enrichment
How did you learn about Student Support Services?
*

Eligibility:
Citizenship *
Did your Mother graduate with a 4 year bachelor's degree? *
Did your Father graduate with a 4 year bachelor's degree? *
Do you have a documented physical or learning disability? *
If Yes, have you registered with Tech's Disability Services or Arkansas Rehabilitative Services

If you have a documented disability and are registered with ATU Ozark Disability Services or Arkansas Rehab. Complete the following: 

Disability Verification Form

Financial Eligibility:
Where you born before January 1, 2002? *
Are you married? *
Are you a veteran of the US Armed Forces? *
Are you currently serving on active duty in the US Armed Forces for purposes other than training? *
At any time since you turned age 13, were both of your parents deceased, were you in foster care, or were you a dependent or ward of the court? *
Do you have children who receive more than half of their support from you? *
Do you have legal dependents other than a spouse who receive more than half of their support from you? *
Are you an emancipated minor or are you in a legal guardianship as determined by a court? *
Dependent Student: You are a dependent student if you selected no for all the above questions in the financial eligibility section.
If you are dependent student, please provide a parent/guardian email so we can verify income.
Independent student: You are an independent student if you selected yes to any of the questions in the financial eligibility section
Independent Students Only: Number of people in your family, including yourself from you 2024 taxes
Independent Students Only: Taxable Income, Found on IRS form 1040, line 15, for 2024 taxes. If you did not file because you made less than required to file, Enter a Zero

Sign and Submit:

Student Informed Consent Agreement

I certify that the information I have provided is true and correct to the best of my knowledge. I give my consent for Arkansas Tech University Student Support Services Program to release and receive academic and/or financial aid information in order to provide appropriate services.
Applicant Signature *
Signature Type: Simple    Start Over
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Signature: (Type in your full name)
I agree to the terms included.