SSS Program Application Form

  • Program Application Form

    This program is funded $327,836 annually by the U.S. Department of Education.
  • Format: (000) 000-0000.
  • Date of Birth*
     - -
  • Sex*
  • Race*
  • Do you identify as Hispanic/Latino/Latinex?*
  • Date of Enrollment at MSU*
     - -
  • Date you are attending Racer Nation Orientation (RNO) at MSU
     - -
  • Will you participate in an early move-in program? (SDS, Racer Band, Sports Program, Smooth Move, etc.)
  • Have you participated in any of the following TRIO programs? (check all that apply)*
  • Do you have an application for Federal Financial Aid (FAFSA) on file with the MSU Financial Aid Office?*
  • Are you a veteran of the U.S. Armed Forces?*

  • Eligibility Criteria:

    Funding for the SSS program is provided by the U.S. Department of Education and requires specific documentation for enrollment into the TRIO Student Support Services program.
  • Citizenship Status: Are you a U.S. citizen or permanent resident? (CFR646.30: a citizen or national of the United States or meets the residency requirements for Federal student financial aid assistance.)*
  • First-Generation status (parent(s) or guardian(s) educational level)*
  • Residency Status-who you live with (check all that applies)*
  • Using the following criteria, are you considered homeless? 1.) Lack a fixed, regular, and adequate nightime residence. (i.e. couch surfing) 2.) Primary nightime residence is a public or private place not designed for or ordinarily used as a regular sleeping accomodation for humans. 3.) Share the housing of other persons due to loss of housing, economic hardship, or similar reason. 4.) Currently living in a hotel, motel, trailer park, or campground due to lack of alternative, adequate accomodtions. 5.) Currently living in an emergency or transitional shelter. 6.) Currently living in a car, park, public space, abandoned building, substandard housing, bus or train station, or similar setting.*

  • Disability Status (optional)

  • Do you have a documented disability
  • If yes, are you able to provide documentation of disability to the SSS office?
  • If yes, are you registered with the MSU Student Disability Services department?
  • If yes, do you have documentation on file with the MSU Student Disability Services department?

  • Academic Goals

  • Have you taken or will you take any developmental/corequisite courses at MSU?*

  • Earnings Certification

  • Household size and income: what is your federal tax filing status according to your most recently filed federal taxes?*

  • Federal Taxable Income:

    You do not need to reveal your family's exact income to determine if you are income eligible for the Student Support Services project.

  • If your family's taxable income is below the figure which corresponds to your family size, select "Yes" for the following "Does your income qualify" question. (To determine your taxable income, refer to line 15 on your 2023 Federal Tax Return)
  • Does your family size and income qualify you?*
  • Did your family file taxes in 2023?*

  • Please certify that all the information provided in the above sections are true, correct, and complete. (If the applicant is under the age of 18 on December 31st of last year, a parent or guardian must sign below.)

  • 1st professional reference: First Name * . Last Name * .

  • Format: (000) 000-0000.

  • 2nd professional reference: First Name * . Last Name * .

  • Format: (000) 000-0000.

  • Release of Information/Student Publicity Release

    I certify that the information I have provided on this application is, to the best of my knowledge, complete and accurate. Futhermore, I understand that by applying for the Student Support Services program. I authorize SSS staff to obtain any personal, financial, academic, or medical information relevant to my participation in SSS. I also authorize SSS to release information including, but not limited to, my class schedule, academic/educational information, and financial aid information to the U.S. Department of Education and other appropriate federal and/or state agencies. The SSS staff also has my permission to communicate verbally or otherwise with staff, facilty, and/or off-campus professionals on my behalf.

  • I agree that if I am accepted into the Student Support Services program, the staff may use my name or picture in publications, bulletin boards/posters, social media outlets, and/or campus publications for the purpose of highlighting accomplishments and participation in campus and SSS activities.

  • Participant Requirements

    To be a participant in Student Support Services program at Murray State University, I agree to do the following: 1.) Complete a needs assessment with a SSS staff member each Fall and Spring semester. 2.) Create an academic plan through the individualized academic map process (I-MAP). 3.) Receive services based on my needs assessment and Plan of Action provided by SSS. 4.) Each semester, I will update my academic plan by identifying needed services. 5.) Meet with a SSS staff member a minimum of one time (1) each semester for academic counseling services.

  • Required Services

    (based on need) include; Career Counseling, Post-Secondary Course Selection Assistance, Federal Financial Aid Counseling, Financial & Economic Literacy, and Graduate & Professional School Counseling.

  • Permissible Services

    (based on need) include: Career Counseling, Study-Skills Enhancement, Cultural & Academic Programs, and Personal Developement.

  • By signing this form, I agree that all responses contained in this application are true and accurate.
  • Should be Empty: