Viterbo University - The University of Opportunity: Hope and Help

Student Support Services Forms

STAR 2015 

Dear Student and Family,

In the Academic Resource Center we have a program called Student Support Services (SSS). This program is funded by federal dollars and provides outreach to students to help with their college adjustment. The goal of SSS is to encourage student success and assist in the connection to life at Viterbo University. 

The program is limited to 200 students who: are first generation (meaning neither parent has a four-year college degree); have a family income below an amount the federal government designates or have a diagnosed disability. You need to fit only one of the criteria. While a large percentage of our students meet one of the categories, the program is limited to approximately 70 freshmen. An attraction of this program is that you may receive free tickets to events in the Fine Arts Center.

On the form below, enter the family’s taxable income for 2014, found on Line 43 on the 1040 tax form (NOT adjusted gross which is reported on the FAFSA) AND the number of individuals in your household claimed on tax forms. All information is kept confidential. Families earning a taxable income that exceeds $35,000 may designate N/A, complete and submit the form.

Once you arrive on campus in fall, you will be notified if you have been chosen for the Student Support Services program and you will be invited to meet with a staff member in the Academic Resource Center. Our hope is to establish a relationship with you and assist in your college success and adjustment.

Questions? Please call me at 608-796-3194 or email We look forward to working with you.


Jane Eddy, Director
Academic Resource Center and Student Support Services

If the student is on a parent’s tax return, provide information about parent’s income. If financial aid is based solely on student’s earnings, provide student’s taxable income. 


Student's name   Cell phone  
Did either parent graduate from college with a bachelor’s degree (this does not include a technical or two-year degree)? 
Family’s taxable income for 2014 (line 43 on 1040)    # of exemptions  
Signature of person who filed tax return  
Parent email address  
 Proposed Plan of Student Involvement in 
Student Support Services (SSS) Program 2015-2016
The following information indicates my proposed plan of involvement in Student Support Services:

1. As the need arises, I will seek support in these areas: (check all that apply)

2. As the need arises, I will utilize the following counseling services: (check all that apply)

3. I will participate in the cultural aspect of the program, which entitles me to free tickets at the Fine Arts Center:

As a member of SSS, I agree to meet with the assigned academic counselor in the Academic Resource Center. 

Student signature