Thank you for your interest in the UNM Valencia Student Support Services program!  Please complete this application as thoroughly as possible.  You cannot save and restart this application.  You may want to review the included items, take some time to make notes and gather the required documents, and then return to submit your application.  If you have any questions, please call our office at (505) 925-8549.

Referred by *
Please explain your primary reason for applying to our program: *

General Information:
First Name *
Middle Name *
Last Name *
Social Security Number *
Gender *
Date of Birth *
Marital Status *
Permanent Address *
Local City *
Permanent State *
Permanent Zip *
Cell Phone Number *
Local Phone *
Work Phone Number *
Email Address *
THE USDE REQUIRES INSTITUTIONS TO COLLECT DATA ON RACE AND ETHNICITY. Please choose from below: If Hispanic, please choose one additional option
Race, Hispanic
Race, White
Race, Black or African American
Race, Hawaiian or other Native to Pacific Island
Race, American Indian or Alaskan Native
Race, Asian

Academic Information:
College Grade Level (Start) *
How many credits are you currently enrolled in? *
Current GPA: *
How is your academic standing? *
UNM Valencia Major *

Family Information:
Parent"s Educational Leve: *
How many people in your household at home? *
Family Income Range *
Eligibility *
Most current IRS 1040 *

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.

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Please select a signature verification type.