Student Support Services Application
    First Name:
Last Name: Date of Birth:
College Entrance Date: Gender: Male Female
US Citizen: Yes No    
College Grade Level:
Ethnic Type:
Activites:
AG Art Band Baseball Basketball Choir
Cheerleading Dance Drama Football Quiz Bowl Rodeo
Softball Journalism Track Student Senate Volleyball  
Career Major: Email Address:
Local Address: Permanent Address:
Local City: Permanent City:
Local State: Permanent State:
Local Phone: Permanent Phone:
 
Academic Information:
Has either of your parents completed a Bachelor's (four year) degree? Yes No
Do you need any type of academic support for college sucess? Yes No
Do you have a documented disability? Yes No
Do you have a high school diploma? Yes No
Do you have a GED? Yes No
Expected date of graduation from FSCC?
Highest level of education desired? 2 Year Degree 4 Year Degree Other
What colleges are you considering when leaving FSCC?
 
Financial Information
Have you applied for Federal Financial Aid? Yes No
Have you received any Federal Financial Aid? Yes No
Have you received any scholarships? Yes No

 		 If yes, please list:
  
For tax filing purposes, what is your (or you parents) standard deduction?
Single, no dependants
Joint, no dependants
Single head of household
Married, filing separate
Married, filing jointly
Unknown
 
Agreement

 I hereby authorize the release and receipt of educational and personal data as deemed necessary by the Director of Student Support Services and/or Student Support Services Counselors to Fort Scott Community College faculty and staff including Financial Aid, Registrar, and Disability Services offices for official use. Your information is also released to the U.S. Dept. of Education. To the best of my knowledge and belief the information on the application is true and correct.