Last Name: First Name: MI (Maiden Name)
Student SSN# Student ID# D.O.B.
Date Began Attending HSU (MO/YR) Year of High School Graduation or GED Year
If 'Other Race', please specify:
HSU Mailing Address: HSU Phone: (Dorm/Apt) (Cell)
Home Address: Home Telephone
City State ZIP
Please list your HSU email address (Example: email@example.com)
Student Support Services will use your HSU email address, your HSU Phone (dorm or cell), and your current HSU mailing address for corresponding with students.
It will always be the responsibility of the student to check his/her email and regular mail. It is also a student responsibility to stay in contact with Student Support Services Education Specialists and staff to learn of SSS activities.
Have you ever been in the care of a state Foster Care system:
Is English Your first language:
If NO, what other languages are spoken in your home:
If you have been out of the Educational Pipeline for 5 or more years, please specify:
College Major: Interested in attending Graduate School:
Transfer from (if applicable): Do you already have a 4 yr. college degree?
Are you a full-time (12 or more hours) student?
If you are not an American citizen and you are a permanent resident, give your card number:
Do either of your parents have a 4-year college degree?
Do either of your parents have an Associate's degree?
Do you receive Financial Aid? (Yes or No) (To use income as a qualifier, you must file FAFSA or provide Tax Returns)
Do you have a documented disability? (Yes or No) If so, what is your disability?
If you said 'Yes', your application may be forwarded to SSDS for consideration.
Have you ever been in the HSU DRC/SSDS Disability program? (Yes or No)
Have you participated in Trio programs? (Veteran's Upward Bound / Talent Search / E.O.C / etc.) If so, where:
READ: I hereby consent to the release of all my HSU student records to Student Support Services. I also hereby authorize SSS to release information as it pertains to my educational success to professors and/or staff and agree to the use of my name and photograph in news releases, SSS newsletters, SSS mailings or SSS email notices.
SSS Services Needed
- To be eligible for employment as a tutor, you must have one semester at HSU and meet job requirements
Computer Instruction Needed
Write a statement about yourself - Required