• Student Support Services – Application

    2026-2027 Cohort

  • To determine eligibility, please complete this form. The information you provide is strictly confidential. Because this is a federally funded program, this information is required for students who wish to participate in the Student Support Services program.

  • Date of Birth*
     - -
  • Do we have permission to text you?*

  • Academic Information

  • Entry Date to MSU*
     - -
  • Expected Date of Graduation*
     - -
  • Classification*
  • Enrollment Status*
  • Are you a transfer student?*
  • Entry Date to College (if elsewhere)
     - -
  • Did you pass all portions of the TSI test?*
  • If not, which TSI sections did you not pass? Mark all that apply.
  • Have/Were you required to enroll in Remedial Coursework?*
  • Are you currently on academic probation?*

  • Financial Aid/Income Information

  • Have you completed the FAFSA for the 2026-2027 Year?*
  • Does someone claim you as a dependent on their tax return?*
  • Do you have children you provide care for ≥ 50% of the time?*
  • What type of financial aid are you receiving?*

  • Previous Grant-Program Participation

  • If you previously participated in another TRIO / other federally-funded program, please check which one(s):

  • Demographic Information

  • Ethnic Identity- Please check the identity that describes you best.*
  • At any time since you turned 13, were both your parents deceased, were you in foster care, or were you a dependent or ward of the court?*
  • Are You a U.S. Citizen?*
  • Gender*

  • Parent’(s)/Legal Guardian’(s) Highest Level of Education

  • Disability Verification

  • Do you have a documented disability?*
  • Have you been diagnosed as having a learning disability?*
  • Have you been diagnosed with a physical disability?*
  • Are you registered or do you plan to register with MSU’s Disability Support Services?*
  • Are you currently receiving services from The Department of Assistive and Rehabilitative Services (DARS)?*

  • Academic and Needs Assessment

    Please check which services you would like to receive from SSS
  • Counseling*
  • Tutoring*

  • Educational Motivation

  • Rows
  • Rows

  • Please Check true or false for the following questions

  • I have set a goal to do well in college*
  • Good grades are a matter of luck and timing*
  • I spend two hours studying for every hour I am in class*
  • It must be quiet when I study*
  • I know how to take notes in class*
  • I study at home*
  • When a subject is difficult for me, I study the easy parts*
  • I finish assignments on time*
  • I read over my course materials before class*
  • I frequently wonder if school is really worthwhile for me*
  • It is up to my professors whether or not I will learn in class*
  • I understand and accept the responsibility of doing well in college*
  • Mark the box next to the statements that apply to you*

  • CONTRACT

  • I understand that I will have access to the Midwestern State University Student Support Services (SSS) staff members and will have use of the SSS facility and all available services. I am aware that I am required to update my Academic and Career Evaluation Plan each academic semester to ensure my file remains current and to determine the nature of the services I need.

     

    I understand that I will meet with a staff member once a month during each academic semester, and I will obtain tutoring should my grade(s) fall below a C average. If I am on academic probation, I agree to have contact with SSS at least two times a month in order to develop a plan to improve my academic standing.

     

    I hereby give permission for SSS staff to disclose and receive information concerning the nature of my SSS eligibility and information concerning my academic progress on an as-needed basis with appropriate faculty and staff at MSU Texas. I also give SSS staff permission to view and receive any and all financial aid information from the Financial Aid Office.

     

    My signature verifies that I have read and understood this contract, and that the information I have provided on this application is true and accurate to the best of my knowledge.

  • Clear
  • Date*
     - -
    • Submit 
    • Should be Empty: