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Student Support Services Application

  1. COMPLETE: Please read each question carefully and complete all sections. If you fail to answer all of the necessary questions, your application will be returned to you for completion. The information you provide on this form will be kept confidential.

  2. INCOME ELIGIBITY: We will request your financial records from the Office of Scholarships and Financial Assistance for review.

  3. DISABILITY: Please email documentation to ssswebp@wp101ways.com. Contact us at ssswebp@wp101ways.com with questions about what documentation we can accept.

  4. TRANSCRIPTS: Your Academic Transcripts/Records will be requested from the Admissions Office by staff from Student Support Services (SSS). You will not need to provide them.

  5. INTERVIEW: You will be contacted after turning in your application to interview with an SSS staff member in person. The interview will last 15-20 minutes.

  6. QUESTIONS: If you have questions about the application process, please call our office at 660.562.1862.

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All fields are required.

Step 1: Demographic Data

Applicant Information

Applicant Name:













School Information




University Status:

Demographic

Gender:
Ethnic Background:
Racial Background:
Are you a U.S. citizen?
Are/were you any of the following?

Parent Information

Have either of your parents/guardians received a bachelor’s degree?
Father's Education: (mark highest level completed)
Mother's Education: (mark highest level completed)

Statement of Disability

Do you have a physical, mental, or documented learning disability?

If yes, please email documentation to ssswebp@wp101ways.com. Contact us at ssswebp@wp101ways.com with questions about what documentation we can accept.

Step 2: Income Eligibility

Do you have an application for Federal Financial Aid (FAFSA) on file with Northwest Missouri State's Office of Scholarship and Financial Assistance?
Do you qualify for financial assistance? (check all you applied for)
Parent Marital Status: (student, if independent)
How did you hear about the Student Support Services Program?

Step 3: Assessment Data


Do you plan to graduate with a bachelor's degree from Northwest?



Step 4: Student Performance Agreement

I understand that the Student Support Services Program will use the data provided on this form to assist in assessing any academic and/or career planning needs and that all of the information will be kept confidential. I release the following information to the Student Support Services (SSS) Staff: high school transcripts, SAT/ACT scores, Northwest graduate reports and instructor evaluations, financial assistance award notices and income information, vocational rehabilitation records and any other information from my academic records pertaining to my enrollment in Student Support Services. Submitting this application verifies that all information contained herein is true and complete.
   

TRIO SSS provides opportunities for academic development, assists students with college requirements, and motivates students towards successful completion of their postsecondary requirements. The goal of SSS is to increase the college retention and graduation rates of its participants. This agreement shows the expectations Northwest Missouri State University’s TRIO SSS has of its participants to help meet these goals. Students accepted in our program will participate for up to 6 years or until graduation from Northwest Missouri State University, whichever comes first.

Summer Bridge Scholar Commitments

Please read and check the boxes to demonstrate your commitment:

I will arrive on July 30, 2023 and stay for the entire TRIO Summer Bridge Scholar program located on the campus of Northwest Missouri State University and participate in all academic, social and scheduled activities.
Attendance Agreement    

I will have no other time commitments, during the TRIO Summer Bridge program. This includes, but is not limited to personal or work commitments, summer programs or tryouts during July 30 - August 1, 2023.
Commitment Agreement    

I will comply with all rules, regulations and policies of Northwest Missouri State University.
Compliance Agreement    

 

I have completed the 2023-2024 FAFSA.
FAFSA Agreement    

I will enroll in and successfully complete TRIO's course for bridge students during the Fall term.
Course Enrollment Agreement    

I understand that at the completion of the 2023-2024 academic year, I will receive a $1000 scholarship that applies to my 2024-2025 school year, if I meet the following criteria:

  • I have participated in all summer bridge activities.
  • I am in good academic standing./li>
  • I have actively participated in the TRIO SSS program (attended coach meetings, peer mentor meetings, and SSS hosted events).
Scholarship Agreement    

Student Member Responsibilities

Please read and agree to demonstrate your commitment:

Meet with TRIO SSS academic success coach twice each semester, more as needed.
   

Meet with the TRIO SSS financial literacy coordinator annually, more if needed.
   

Meet with TRIO SSS peer mentor twice each semester, more as needed.
   

Attend at least three events organized by TRIO SSS peer mentors and professional staff.
   

Improve my academic skills by utilizing one or more resources below:

  1. Meet with TRIO SSS professional staff for an academic recovery plan.
  2. Meet with a tutor in the Student Success Center (SSC), Math Lab, or Writing Center.
  3. Attend Supplemental Instruction (SI) sessions.
  4. Meet with my TRIO SSS peer mentor for pre-tutoring sessions.
   

Confidentiality Agreement

  • Students and staff are expected to follow a code of ethics.
  • TRIO SSS peer mentors and professional staff will remain confidential to the extent of the University guidelines.
  • You have the right to see one of the professional staff instead of a peer mentor.
  • You have the right to see any documentation as recorded by peer mentor staff.
  • Information in your file may be used for statistical and /or research information, but your name will be kept confidential at all times and used only to comply with federal reporting requirements
   

Northwest Missouri State University Academic and Professional Waiver

I give my permission to the TRIO and Student Support Services professional staff (SSS assistant director, academic success coach, financial literacy coordinator) to do the following:

  • I authorize the release of academic, financial and any other information in my SSS files unless and until this authorization is specifically withdrawn in writing by me.
  • I authorize the release of my records to and from when necessary: parents/guardians, instructors at Northwest, the Office of Equity and Accessibility, Vocational Rehabilitation counselors, Wellness Center and other professional personnel when needed.
  • I authorize the release of academic records from the Registrar’s Office, Advisement Office, Admissions Office and Student Success Center for semester reports that include and are not limited to grade reports, class enrollment, tutoring reports, graduation reports, SAT/ACT Scores, transcripts (high school, other post-secondary institutions, Northwest).
  • I authorize SSS staff to receive information from and communication with any Northwest departments and other Northwest administrators and on my behalf when the sole purpose is to promote educational opportunities for me.
   

Student with Disabilities Waiver

I   give my permission to the TRIO Student Support Services professional staff to share limited disability-related information about me with my TRIO SSS Peer mentor so that they may adequately assist me in my academic progression and success at Northwest Missouri State University.

Signature

Electronic Signature Acknowledgement: By completing the Signature field, you are signing the document electronically. You agree your electornic signature is the legally binding equivalent to your handwritten signature, and you are also confirming that you are the individual named in the electronic signature, and that you are authorized to sign this document.

By submitting this form, I certify that all the information I have typed into this form is correct and I understand that any false information (or omissions) in the contract agreement or its supporting documents will be sufficient grounds for TRIO SSS application denial.


Opting out of electronic signature will cause delays in processing.
Print and sign the Signature Page. Return instructions included on the document.

Download Signature Page View PDF

Finalize your online application by clicking "Submit Application" button below.

 

To retain a copy of this application for your records,
PLEASE PRINT THIS PAGE NOW!

 

    

 

Northwest Missouri State University
TRIO SSS Office
Administration Building 372 - West Wing
800 University Dr.
Maryville, MO 64468

Phone: 660.562.1862
Fax: 660.562.1631
Email: ssswebp@wp101ways.com


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