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Thank you for your interest in the Arizona Western College Student Support Services (KEYS) Program. The KEYS Program has a long and rich history of ensuring that all students, regardless of gender, ethnicity, economic status, educational background, and/or disabilities have equal access to higher education, support, and resources necessary to graduate from college. We are a federally-funded program through the U.S. Department of Education.

General Information

According to Federal guidelines, you must also select which race you identify with most. Please select one or more races that apply to you

Select all that apply.

Are you of Hispanic, Latino, or Spanish origins?


Do either of your parents have a bachelor degree?
Do you have a documented disability?

(i.e. physical, learning, psychological, or other)

Are you eligible to receive Federal Financial Aid (i.e. Pell Grant)?

Income Tax Verification (Not Optional)

In addition to being a US Citizen or Permanent Resident, a large percentage of the program participants must be eligible based on family income and size. Therefore, our records must contain certain information for verification of eligibility in the KEYS program. The information you give us will be kept confidential and only used for eligibility purposes. The information is protected by the Federal Privacy Act.

(I am not at least 24 years of age, married, or have dependents, have not served in the US armed forces) *Parent tax information is required as income tax verification
Taxable income can be found on line 15 from the most recent tax year - 1040 Forms
(I am 24 years of age or older, married and/or have dependents, and/or served a veteran of the US Armed Forces, and/or an orphan or ward of the court until age 18.)
Taxable income can be found on line 15 from the most recent tax year - 1040 Forms
Please check the documentation you used to answer the question

Education Details

Is this your first semester of college?
I am seeking a
What other support programs have you participated in

Transfer Information

Do you plan to obtain a 4-year Bachelor Degree?

Services Needed

What are your needs or concerns?

Please check all that apply.

Release Information

I verify that all the information on this form is accurate and complete to the best of my knowledge. I understand that all information provided will be kept confidential and will be used to determine eligibility and services needed. I hereby give the KEYS Program permission to obtain information regarding my financial and academic status. If I identify a disability, I grant permission to the AWC AccessABILITY Resource Services to release necessary information to KEYS Program staff for the purpose of verifying eligibility. If accepted, I will participate as required by the KEYS Program. I also grant the KEYS Program my permission to use my photograph, image, and videotape, or otherwise record of my participation in program activities and to reproduce and use such recordings. I hereby grant permission to KEYS Program to use my name, likeness, voice and/or biographical information with any media format which includes, but is not limited to: non-commercial promotional activities, newspapers, magazines, television, radio, film, and/or on the internet. Also, my consent is freely given as a public service to KEYS Program without expectation of payment. I understand that KEYS program is required to transmit my personal information to the U.S. Department of Education. Specific individual information reported on me can be found in Section III of the KEYS annual report and contains information such as my name, SSN, cum. GPA, academic standing, biographical information, and financial aid information.

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