Online Monitoring Form

Student Support Services
<<---Back to SSS Webpage Please make sure to answer all questions. The U.S. Department of Education requires verification of your income status. Please bring a copy of your most recent IRS Income Tax Forms for: Yourself: if you file as an individual and you are not claimed as a dependent on someone else's income tax forms...or Your parents (or other guardian): if you are a dependent on someone else's income tax forms. THE DEADLINE TO COMPLETE AN APPLICATION FOR THE FALL 2008 SEMESTER IS August 1, 2008. ANY APPLICATIONS RECEIVED AFTER THAT DATE WILL BE CONSIDERED FOR THE SPRING 2009 SEMESTER. We recommend you print a copy for your records. If you have any questions or comments please contact Student Support Services at (432)335-6476 or come by our offices located on the 2nd floor of the SUB building Room 213. Thank you for your interest in our program and we look forward to meeting with you soon.

Last Name:	Social Security Number:
First Name/Middle Initial:	E-mail Address:
Temporary Address:	Student ID Number:
Permanent Address
Which address would you prefer to receive your mail at?	Temporary Permanent

Phone Number:	2nd Phone Number:

Place of Birth:	Date of Birth and Age:

US Citizen or Permanent Resident?	Yes No

Marital Status?	Single Married Divorced Separated Widowed

Race?	American Indian White African American Asian/Pacific Islander Hispanic Other

Academic Plans?	Upgrade Skills 2 yr Degree 1 yr Certificate Transfer to 4 yr University

How did you hear about the SSS program?	OC Students Faculty Staff SSS Staff Other

Do any of your parents have a Bachelor's degree?	Yes No

How much longer do you plan to attend OC?

Have you attended any other colleges or universities?	Yes No
If yes, where?	How many hours did you earn?

Are you currently receiving financial assistance from any of the following agencies?	AFDC TRC WIA WIC AFDC OTHER

What is your desired occupation?

What is your major?

Are you a GED recepient?	Yes No

Are you, or were you ever, part of a program called Talent Search, Upward Bound, or Student Support Services?	Yes No

Do you have any learning disabilities?	Yes No
If so, what?

Do you have any physical disabilities?	Yes No
If so, what?

Had (Have) you been out of school for more than 5 years before you started attending OC?	Yes No

Are you a single parent?	Yes No

How many people, including yourself, live in your household?

Do you work?	Yes No

If so, where, and how many hours?

Why would you like to be a part of the Student Support Services Program at Odessa College?
Describe your motivation for getting an education. You may discuss your goals and how important getting an education is to you.
Tell us a little about yourself [family, hobbies, extracurricular activities, background (low income, status, parent's level of education, disabilities)]

I certify that I am enrolled or have been accepted at Odessa College. I agree to provide, if requested, any documentation necessary (transcript, financial aid data, etc.) to verify information for participation in the Student Support Services program and/or permit the Student Support Services Staff to obtain necessary paperwork.