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APPLY FOR PARTICIPATION

Please fill out the form below and you will receive a confirmation at the Lincoln University email address you specify below.

DEMOGRAPHIC DATA

Your Name

Social Security Number

Campus Address

Dorm or Local phone

LU email address

Date of birth

Gender

male

female

Ethnicity

Black/African-American	Hispanic
Native Hawaiian/Pacific Islander
Native American/Alaskan Native	Asian
White/Caucasian	other

Eligibility Criteria

Are you a US citizen?

yes

Do your parents have a bachelor's degree?

mother	yes	no
father	yes	no

Do you have a learning and/or physical disability?

yes

If yes, is your disability on file with Counseling and Career Services?

yes

Did you apply for federal financial aid (fill out and turn in a FAFSA)?

yes

If no, please indicate the number in your household

Approximate yearly family gross income

If yes, were you eligible for financial aid?

yes

Administrative Information

How did you hear about SSS?

Addmissions Office	instructor
New Student Orientation	brochure
Lincoln University bulletin	friend
	other

Important! Please Read

Clicking "sign and send" constitutes your legally binding signature on this document. By doing so, you agree to the following:

I hereby authorize the release of all appropriate and/or personal documents and information necessary to verify my eligibility and track my progress in the Student Support Services program.