Waubonsee Community College -- Student Support Services Application

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Student Support Services Application

	Because we are funded by the US Department of Education, we are required to ask for income and education information from the families of the students we serve.

There are three parts to this application. Please be sure to complete:
Part 1-- Demographic Information
Part 2 –Application Essay, and
Part 3—Documentation of Income Status Form

PART 1:

Social Security Number:	(example: 123-45-6789)
Your Full Name:
Address:
City:
State:
Zip Code:
Home Phone:	(example: (630) 555-1234)
Work Phone:	(example: (630) 555-1234)
E-mail:
Birthdate:	(example: Jan. 1, 2003)

Please provide us with your gender?
	Male Female
Are you a United States citizen?
	Yes No (* If no, documentation of permanent residency required.)
Ethnic Background: (please check only one)
	American Indian/Alaskan Native Asian Black/African American Hispanic/Latino White Hawaiian/Pacific Islander More than one race reported
Is English your first (primary) language?:
	Yes No
Type of high school certificate:
	High School Diploma GED Foreign Secondary Other:
WCC career major:
Waubonsee Community College degree desired:
	AA AAS AS AGS AES Certificate
I plan to transfer to a four year institution:
	Yes No
Did your custodial parent(s) or guardian(s) receive a Bachelor's degree before you were 18?:
	Yes No
Do you have a physical or learning disability?:
	Yes (* If yes, documentation is required.) No
Have you completed a file for Financial Aid at Waubonsee?:
	Yes No (*If no, see below)
	(* If no, you must submit a copy of your 2007 Federal Income Tax form, or your parent's if you are under age 24.)
Have you completed assessment testing at Waubonsee?:
	Yes No
This year I may need help with:
	Tutoring Study Skills Financial Aid Choosing a major/career Personal/family issues Transferring Other:
How did you hear about us?:

PART 2:

Application Essay

Please complete the following essay. Your essay will help to determine if Student Support Services is right for you. Think in terms of what challenges you face in your education, and how Student Support Services can help you overcome those challenges.

PART 3:

Download and Mail Documentation of Income Status Form. (82k PDF)
(Click here to download Adobe® Acrobat.)

Mail To:
Student Support Services
Waubonsee Community College
Route 47 at Waubonsee Drive
Sugar Grove, IL 60554

Federal regulations require that this form MUST be completed by one of the student’s parents/legal guardian if the student is under 24 years of age. If over 24 or married, the student may complete and sign it. Student Support Services is a federally-funded grant program. A certain percentage of our participants MUST be from low-income homes. By program regulations therefore, we ask everyone to provide documentation so that we may determine who qualifies. We request your 1040 form.

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