Student’s Last Name, Student’s First Name, Student’s Middle Initial

Student’s Social Security Number

Student’s Date of Birth

Student’s Permanent Street Address, Student’s Permanent City, Student’s Permanent State, Student’s Permanent Zip Code

Student’s Permanent Home Phone Number

Student’s E-Mail Address

Student’s Citizenship Status

Student’s Alien Registration Number

Is the Student Male?

Register Student for Selective Service?

Student Born Before January 1, 1984

Parents Deceased?/Student Ward of Court?

Is Student on Active Duty in U.S. Armed Forces?

Is Student a Veteran?

Student’s State of Legal Residence

Was Student a Legal Resident Before January 1, 2002?

Student’s Legal Residence Date

Student’s Driver’s License Number

Student’s Driver’s License State

Is Student Married?

Student’s Marital Status

Student’s Marital Status Date

Does Student Have Children He/She Supports?

Does Student Have Dependents Other than Children/Spouse?

Student’s Number of Family Members in 2007-2008

Student’s Number in College in 2007-2008

Student Received Supplemental Security Income?

Student Received Food Stamps?

Student Received Free/Reduced Price Lunch?

Student Received TANF?

Student Received WIC?

HS Diploma or GED Received?

Type of Degree/Certificate

Student’s Grade Level in College in 2007-2008

First Bachelor’s Degree by July 1, 2007?

Working on Master’s or Doctorate in 2007-2008?

Interested in Work-Study or Student Loans?

Drug Conviction Affecting Eligibility?

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”@” Correction Flag Image

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