University of Alaska Fairbanks

Student Support Services STEM program application 

Please complete this application and submit, you will be contacted with your application status within 5 business days.

Note: you are not able to save your progress and return to the form later.

If you have any questions, please call our office at (907) 474-6844.

Last Name *
First Name *
Middle Name *
Preferred Name
School ID *
Social Security Number *
Permanent Address *
Permanent City *
Permanent State *
Permanent Zip *
Permanent Phone *
Email Address *
Cell Phone Number:
Preferred Contact Method *
Referred By: (First/Last Name)
Eligibility Information
Are you a First Year Student?
U.S. Citizenship
Are you enrolled or planning to enroll in at least 9 hours' worth of classes?
Are you Admitted to a 4-year STEM degree program?
What program are you admitted to? *
Are you a low-income student?
Did you receive the Pell Grant? *

Are you a first generation college student?

A first generation college student is defined as a student whose parent(s)/legal guardian(s) have not completed a U.S. bachelor's (4-year) degree.

Do you experience a documented learning or other disability? *
If YES, are you registered with UAF Disability Services?
If you selected “no” to the question above: To better serve our student population, and to meet requirements as a federally funded program, we have partnered with Disability Services on campus to verify disability documentation. Please contact their office at (907) 474-5655 to coordinate verification. You may also email them at or visit their website at
Demographic Information


(select all that apply)

Race, American Indian or Alaskan Native
Race, Asian
Race, Black or African American
Race, Hawaiian or other Native to Pacific Island
Race, Hispanic
Race, White
Class Standing
Family Status
Where are you planning to live?
Date of Birth
What support do you hope to receive from Student Support Services? *

Student Self Assessment

Please check everything that applies to you

Attended high school with fewer than 100 in graduating class
Limited legal rights or on probation or parole
Out of academic pipeline for 5 or more years
Working more than 20 hours a week
Working more than 20 hours a week
Defaulted on federal student loans
Single parent without a support system
On public assistance
Commute 20 miles or more a day
Personal decisions interfere w/education and/or career choices
Homeless and/or unstable housing
Aging out of foster care
Other (specify):
Please check any box that refers to a skill or item that you don't have or would like to improve.
Computer Skills
Using basic software (word, excel)
Using Blackboard classes
Using Google Apps (email, calendar, etc) or the internet
Using graphing calculator
Don't have reliable access to computer or home internet
Study Skills
Time management and organization
Test taking/preparation/anxiety
Reading speed and comprehension impacting coursework
Proofreading and essay and research writing
Using library resources
Reading Textbooks
Note taking
Math anxiety
Writing anxiety
Feel unprepared for math, science, and/or engineering courses
Career Planning
Choosing a career or major
Resume and cover letter design
Applying for internships & job shadows
Job Search
Graduate or professional school selection & application process
GRE Preparation
Personal Assistance Referrals
Personal Counseling
Drug/alcohol counseling
Coping with Stress or anxiety
Child care information
Health Issues (Including Seasonal Affective Disorder, SAD)
Disabilities accommodation
Financial Aid Counseling
FAFSA assistance (deadlines, technical support, PIN, etc.)
Student Loan Default
Consumer credit counseling
Loan consolidation
Loan repayment/forgiveness
Financial aid verification
Tax preparation
Terms of Submission:
By submitting this application, you acknowledge that all of the above information is correct and accurate to the best of your understanding.
Please type your name to acknowledge the above statement. *