Student Support Services Online Application

Application Deadline: June 1 for Fall Admission

This application will take 5-10 minutes to complete. The Application is not complete until you have accepted the terms of the contract and submitted your application.

Please answer all questions completely.

Name:

SSN: - -

Contact Information:

Phone:  -   - 
Cell:  -   - 

Permanent Address:

State:      

Local Address:

Check if same as Permanent Address

State:

Are you a U.S. citizen? Yes No

Emergency Contact:

      Phone:  -   - 

Optional Information:

Date of Birth:    Age:    Sex: Race:    Veteran: Yes No

(Note: Birthdate must be in MM/DD/YYYY format.) (To select multiple ethnicities hold down the ctrl and click the selections)

Educational Information:

High School Graduation: Yes No      Year:

GED: Yes No  If yes, what year:

2012-2013 College Ranking:

Are you a transfer student? Yes No

Degree Plans (Check One)

Associate Degree Bachelor Degree

Additional Information

Do you receive any of the following? (Check all that apply)

Social Security Benefits Veteran's Benefits
Vocational Rehabilitation Benefits Public Assistance (KTAP/TANF)

Are you in foster care, aged out of foster care, or adopted? Yes No

Have you participated in other TRIO Programs? Yes No

Educational Talent Search Upward Bound
Student Support Services Educational Opportunity Center

At what school?

Who referred you to Student Support Services?

Eligibility Criteria

The following information is used to determine eligibility for SSS. Failure to complete the following information may significantly delay review of your application

All Sections Must be Completed

1. Income Status of Student


(Line 6 on 1040EZ / Line 27 on 1040A / Line 43 on 1040)
*Household Taxable Income is household income after deductions are taken

  • Does student live with parents? Yes No
  • Does student have children? Yes No

By checking here I agree that all of the information provided under Income Status is true to the best of my knowledge

2. First Generation Status of Student

  • Do either of the student's parents/guardians have a Bachelor's Degree? Yes No

By checking here I agree that all of the information provided under First Generation Status is true to the best of my knowledge

3. Disability Status of Student

Does student have a federally recongnized disability? Yes No

Has student registered with the NKU Office of Disability Services? Yes No

*Your Disability must be verified with the NKU Office of Disability Services 859-572-6373

By checking here I agree that all of the information provided under Disability Status is true to the best of my knowledge

Individual Needs Assessment

Check all that apply to you:

Academics:

  • Unsure high school prepared me for college
  • Achieved a GED
  • Concerned about my math or writing skills
  • Unaware of my learning style
  • Inexperienced with study strategies that work for me
  • Not permitted to declare a major due to SAT/ACT scores
  • It's been more than 5 years since I have been in school
  • Would benefit from tutoring to be successful in coursework

Major/Career:

  • Uncertain about my future career
  • Don't know which majors would be a good fit for me
  • Have a lot of interests but can't seem to pick one major
  • Inexperienced in selecting a major or career
  • Decided about a major but not sure I have the preparation to succeed in it
  • Inexperienced in selecting appropriate courses that would lead to graduation

Personal:

  • Plan to work over 20 hours a week and go to school full time
  • Significant family responsibilites (children, siblings, parents)
  • Significant financial responsibilites outside of school costs
  • Entering college as non-traditional age student
  • Undecided about whether college is for me
  • English is a secondary language for me
  • Need help in managing significant financial responsiblilities

Student Support Services Admissions Contract

If accepted into Student Support Services, I will be eligible for the following benefits..

  • Support Specialist who served as my academic mentor, advisor, career counselor, and resource consultant
  • Super Priority Registration which allows me to register early for classes
  • Enrollment in the SSS Freshman Orientation (UNV 101)
  • Enrollment in the SSS developmental math courses (as needed)
  • SSS student lounge and computer lab
  • Mentoring from experienced upperclassmen - Student Retention Assistant, SSS Teaching Assistants, and SSS Ambassadors

If accepted into Student Support Services, I agree to the following

  • Attend the SSS New Student Orientation
  • I will meet with my Support Specialist at least 4 times a semester
  • As a freshman, I will enroll in an SSS Learning Community or SSS UNV 101 course
  • If I need developmental math, I will enroll in SSS section of MAHD095
  • If I am undecided about a major, I will enroll in CEP 101 for spring semester
  • I commit to working with my Support Specialist in developing a Freshman Plan, Career Plan, and a Graduation Plan to support my academic success, career planning, and timely graduation.
  • I will submit my FAFSA by the March 1 priority deadline and apply for SSS Grant Aid
  • I will review my mid-term progress reports each semester and discuss my grades with my Support Specialist
  • I will read my weekly E-Support Newsletter to stay abreast of program activities, resources and deadlines.
  • I will be honest and conscientious with my Support Specialist and use the services of SSS to help me be a successful college student.

By checking here I agree to the terms and conditions in the Student Support Services Admissions Contract.

Student Support Services - Consent To Release

I understand that Student Support Services needs access to my financial, personal, academic, and disability related information in order to provide the best possible support for me at Northern Kentucky University. Therefore, I agree to release such information to the Student Support Services staff members as long as I am considered an active Student Support Services participant or a student at Northern Kentucky University. I further understand that all released material will remain confidential. Academic information and disability verification, however, will be shared with faculty, University departments, the Office of Testing and Disability Services, and appropriate representatives of the U.S. Department of Education only as necessary. I also agree to allow my name and/or picture to be printed in any SSS newsletter, website, publication or display in recognition of academic success, involvement, leadership, or graduation.

By checking here I certify that I have read and understood this Consent to Release and that I am capable of giving such consent and do so voluntarily.

* Student Support Services is funded by the U.S. Department of Education, Department of TRiO Programs. Acceptance into the program is contingent upon meeting eligibility criteria and space availability.