Student Support Services Application
Apply for Student Support Services here.
Preferred Pronouns (he/him, she/her, they/them, etc.)
Last 4 of Student ID
Date of Birth
State / Province / Region
Postal / Zip Code
FR (0-29 credits)
SO (30-59 credits)
JR (60-89 credits)
SR (90+ credits)
Hispanic or Latino
Not Hispanic or Latino
American Indian or Alaskan Native
Black or African American
Native Hawaiian or Other Pacific Islander
More than one race
At the time of your 18th birthday, did either of your parents have a Bachelor's Degree (4-year)?
I'm Not Sure
If YES, what was the degree in (or their current occupation):
Do you have a diagnosed disability?
If yes, please specify:
(You must provide us with documentation of your disability.)
*Can be provided to the Accessibility Services office at a later date.
On 2021 income taxes, were you a:
For more information, visit: StudentAid.gov/dependency
Size of Family Unit
Income for 2020
Do (or will) you receive any of the following financial aid programs?
If YES, which one(s)?
I hereby grant permission to MSU-Northern Student Support Services to secure the necessary information pertinent to my participation in the SSS Program and MSU-Northern (e.g. financial data, standardized test scores, college/high school transcripts, instructor contact, and disability services). I certify the above information to be true to the best of my knowledge.
The parties agree that this agreement may be electronically signed. The parties agree that the electronic signatures on this agreement are the same as handwritten signatures for the purposes of validity, enforce-ability and admissibility.
Yes, I agree
NOTE: All information requested in this form is confidential and used only to determine program eligibility and for SSS grant reporting. Only aggregate (total/subgroup) data will be used for purposes of federal grant compliance. Please note that you only need to apply ONCE to be considered for the TRIO SSS program.