SOUTHEASTERN OKLAHOMA STATE UNIVERSITY
Student Support Services
425 West University Boulevard
Durant, Oklahoma 74701

Thank you for your interest in our Student Support Services program! Please complete this application as thoroughly as possible. You cannot save and restart this application. You may want to review the included items, take some time to make notes and gather the required documents, and then return to submit your application. If you have any questions, please call our office at (580) 745-2254.

General Information:

First Name: *

Middle Name:

Last Name: *

Student ID Number: *

Date of Birth: *

Gender *

Marital Status *

Local Address *

Local City *

Local State *

Local Zip *

Cell Phone Number *

Personal Email Address *

Student Email Address *

Emergency Contact Name *

Emergency Contact Phone Number *

Where or from whom did you hear about this program? *

Ethnicity:

Are you of Hispanic descent? *

Race (Mark all that apply):

American Indian or Alaskan Native *

Asian *

Black or African American *

Hawaiian or other Native to Pacific Island *

White *

Eligibility:

Are you a U.S. Citizen or permanent resident? *

Have either of your parents completed a four year bachelor's degree? *

Do you have a documented disability? *

Have you submitted your FAFSA application? *

Educational Information:

Intended Major/Career *

Are you registered for classes? *

What is your educational goal? (mark all that apply):

Bachelor's degree

Master's Degree

Doctoral Degree

ACT Composite Score

High School Attended:

Diploma Date:

What College(s) have you previously attended?

Are all transcripts on file at SE? *

How many hours of college credit have you earned?

What degree or certificate have you received? *

Need for Services:

What do you see as your biggest challenge(s) or potential obstacle(s) this semester/year? *

What specifically would you expect our office to assist you with in order for you to achieve your goals? *

Services Available:

Please check all SSS program services that you are interested in:

Academic Advisment

Undecided Major/Career Assessment

Tutoring Services

Financial Aid Assistance

Culturally Enriching Experiences

Financial/Economic Literacy

Graduate School Preparation

Personal Counseling

Grit Scale:

Please respond to the following 12 items. Be honest - there are no right or wrong answers.

I have overcome setbacks to conquer an important challenge. *

New ideas and projects sometimes distract me from previous ones. * *

My interests change from year to year. * *

Setbacks don't discourage me. *

I have been obsessed with a certain idea or project for a short time but later lost interest. * *

I am a hard worker. *

I often set a goal but later choose to pursue a different one. * *

I have difficulty maintaining my focus on projects that take more than a few months to complete. * *

I finish whatever I begin. *

I have achieved a goal that took years of work. *

I become interested in new pursuits every few months. * *

I am diligent. *

Income Verification:

As a federally funded TRIO program, Project: TEACH is required to provide documentation of a Student's eligibility for the program to the U.S. Department of Education and implement the TRIO Regulations that state two-thirds of the students served must meet federal low-income guidelines.

All applicants must complete this section whether or not you believe you qualify as low-income. Verification requirements for TRIO vary depending on whether students are independent or dependent.

To determine whether you are a DEPENDENT or an INDEPENDENT student, please answer the following:

Were you at least 24 years old by December 31st? *

Are you a veteran of the U.S. Armed Forces? *

Are you married? *

Are you an orphan or a ward of the court, or were you a ward of the court until age 18? *

Do you have any legal dependents (other than a spouse), such as children or parents who get more than 1/2 their support from you? *

If you answered NO to every question, you are considered DEPENDENT. Please upload one of the following:

A signed copy of your Parent(s) or guardian(s) most recent Federal Income Tax Return, OR
A copy of the current year Student Aid Report (SAR) which can be found by logging into studentaid.gov using your FSA ID and selecting the View or Print your Student Aid Report (SAR) option [see NOTE below], OR
A document with the statement: "I certify that my parent's TAXABLE INCOME from all sources in the most recent tax year was $_________ with a family size of ____ (include your parents and their dependents). By signing this document, I attest under penalty of perjury that the above statement is true and correct." signed/dated by you AND your parent. (The Taxable Income Information can be found on the IRS 1040 form line 15.)

If you answered YES to any question, you are considered INDEPENDENT. Please upload one of the following:

A signed copy of your most recent Federal Income Tax Return, OR
A copy of the current year Student Aid Report (SAR) which can be found by logging into studentaid.gov using your FSA ID and selecting the View or Print your Student Aid Report (SAR) option [see NOTE below], OR
A document with the statement: "I certify that my TAXABLE INCOME from all sources in the most recent tax year was $_________ with a family size of ____ (include yourself, spouse, and dependents). By signing this document, I attest under penalty of perjury that the above statement is true and correct." signed/dated by you. (The Taxable Income Information can be found on the IRS 1040 form line 15.)

NOTE Regarding SAR: If you used the Data Retrieval Tool (DRT) to transfer any IRS tax information, your Student Aid Report (SAR) cannot be used for income verification.
Questions with the transferred IRS tax information are marked as "Transferred from the IRS."

Upload your Income Verification document(s) here:

By signing below, I authorize the Student Support Services program to obtain, copy, review, and discuss education records and other materials necessary for participation in a Student Support Services program.

I understand that the Student Support Services program reserves the right to admit or deny any student enrollment in a Student Support Services program. Completion of the application does not guarantee acceptance into the program. I also certify that all of the above informations is true and correct to the best of my knowledge. I give the Student Support Services program permission to use my statements, images, voices, or combination of these in promotional items (i.e. brochures, web sites, etc.) Furthermore, I understand that further documentation of income may be needed and all my records will be kept in confidence in accordance with the Federal Education Rights and Privacy Act (FERPA), codified at 20 USC 1232g.

I verify that I am at least 18 years of age, I have read this realize and fully familiar with the contents.

Notice of Non-discrimination: Southeastern Oklahoma State University does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities. The following person has been designated to handle inquiries regarding the non-discrimination policies: Title IX Coordinator, 425 W. University Blvd, Durant, OK 74701, 580.745.3090

Sign and Submit:

Applicant's Signature *

Please select a signature verification type.