Student Support Services Forms
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 2013,
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.
Please call me at 608-796-3194 or email firstname.lastname@example.org. We look forward to working with
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
parent graduate from college with a bachelor’s degree (this does not include a
technical or two-year degree)?
|Family’s taxable income for 2013
(line 43 on 1040) # of exemptions
|Signature of person who filed tax
|Parent email address
Proposed Plan of Student Involvement in
Support Services (SSS) Program 2014-2015
following information indicates my proposed plan of involvement in Student
1. As the need
arises, I will seek support in these areas: (check all that apply)
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.