*Required fields

If you see this don't fill out this input box.

First Name *

Last Name *

Date of Birth *

0/0/0000

Last 4 digits of Social Security Number *

USC Lancaster Email *

johndoe@email.sc.edu

Home Address *

Address, City, State, and Zip Code

Home Phone Number *

(000) 000-0000

Cell Phone Number *

(000) 000-0000

Gender *

MaleFemale

Ethnicity *

African AmericanAsian/Pacific IslandersHispanicNative AmericanWhiteOther (Be specific and explain below)

Other

Did either of you parents or legal guardian complete 4-years of college? *

YesNo

If yes, which parent/guardian?

Do your parents claim you on their Income Tax Return *

YesNo

Number of household members (including yourself) *

Gross Taxable Income (Family income if living with parents/guardians or if living alone) *

Do you have any learning or physical disabilities *

YesNo

If yes please explain briefly

I acknowledge the provided information above on this application is accurate and complete *

Yes