Alpha Scholars

Alpha Scholars Program Application Form

Complete the form below to apply for tutoring and counseling services. If you need disability accommodations, you must complete a separate form. If you prefer, download a PDF version of this form.

(* indicates a required field.)

* 1). First Name
2). Middle Initial
* 3). Last Name
* 4). Local Address Line 1
5). Local Address Line 2
* 6). City
* 7). State
* 8). Zip
* 9). Permanent Address Line 1
10). Permanent Address Line 2
* 11). Permanent City
* 12). Permanent State
* 13). Permanent Zip
14). Email Address
* 15). Local Phone Number
* 16). Permanent Phone Number
*17). Date of this application (mm/dd/yy)
18). Banner ID #
*19). Date first enrolled at ACU (mm/dd/yy)
*20). Number of credit hours completed
21). Age
22). Marital Status
23). Ethnicity
*24). Are you a U.S. Citizen or Permanent Resident? Yes No
25). What is your declared major?
*26). Did either parent/guardian graduate from a 4-year institution of higher education prior to or during the time you lived at home? Yes No
*27). Do you have a documented disability? Yes No
28). If yes, please describe
29). How can you document your disability? school records professional report(s)
30). Other (please describe)
*31). Who claims you as a dependent for income tax purposes?
*32). How many exemptions are included on this income tax form? (include parents and all dependents)
*33). What was the annual taxable income reported on the most current income tax form (line 37 on form 1040)?
*34). Have you applied for financial aid at ACU? Yes No
*35). If yes, are you receiving or do you expect to receive financial aid? Yes No