Mars Hill University-SSS-Application Form

MARS HILL UNIVERSITY

STUDENT SUPPORT SERVICES APPLICATION
The Student Support Services Program is supported by money from the Federal Government. In order to continue to receive money to fund the services we provide, we must have on file certain information about our students. Therefore, it is very important to our program funding that you complete the following information. The information will be held in strict professional confidence and will be used only to meet the program guidelines imposed by the Department of Education.

Services Needed
Name*

First NameLast Name
Date

MonthDayYear
mm-dd-yyyy
What services do you need from Student Support Services?*

Academic Advising/Degree PlanningFinancial Aid AdvisingPersonal MentoringGraduate School Information/AdvisingCareer Counseling (choices, job search skills)Tutoring (please list courses)
Is there additional information you wish to share about how Student Support Services can assist you?
What technology will you bring with you to MHU?*

Laptop/ComputerTabletPhoneI don’t have any electronic devices to bring
Are there other technology needs or challenges that you would like to share?

SSS offers workshops each semester. Please rate the following order 1-9 as they interest you. 1 = most interested/would attend; 9= least interested/would not attend *

	Rating
Overcoming Test Anxiety
Stress Management
Money Management
Note-taking Tips
Time Management
Financial Aid
Getting Organized
Study Skills
Writing an Effective Paper

Are any of the following currently concerns that would affect your academic goals? Check all that apply.*

Feeling depressed or sadFeeling unprepared for collegeLack of a place to studyNo close friends at MHUEasily distractedFamily medical concernsUndecided majorPoor study habitsPoor math skillsPoor writing skillsProcrastinationFeeling out of place at schoolLack of child careProblems at homeRelationship problemsAlways worryingRoommate problemsLack of career goalsRecurring health concernsFinancial concernsAfraid to speak up in classNo support from familyTrouble understanding what I read
Are you currently having trouble with any courses? If yes, please list and explain. *
Do you have any difficulty approaching professors with problems or concerns? If yes, please explain. *
List ALL activities in which you participate other than school/classes (job, athletics) *
Do you have all of your books and supplies for the semester? If no, please explain. *

Income Information
The Student Support Services Program is supported by money from the Federal Government. In order to continue to receive money to fund the services we provide, we must have on file certain information about our students. This information includes family income and educational status. Therefore, it is very important to our program funding that you complete the following information. The information will be held in strict professional confidence and will be used only to meet the program guidelines imposed by the Department of Education.
Please check one*

Dependent student (claimed by a parent or guardian on their taxes).Independent student (at least 24 years old by Dec. 31, orphan or ward of court at 18 years old, married, veteran or active duty military, have legal dependents, or homeless as a minor).
Applicants must submit a copy of their parent(s)/guardian(s) most recent tax return (form 1040). Please submit the tax return of the parent or guardian who claims the student as a dependent. If an independent student, applicant must submit a copy of their tax return.
Tax Return

Cancelof
OR

If you are unable to attach you parent(s)/guardian(s) tax return, your parent(s)/guardian(s) must answer the questions below:
What is your family size according to your most recent tax return?
Enter your taxable income as reported on the most recent income tax return:
*Taxable income can be found on Line 15 on federal tax form 1040
If your income was such that you did not have to file a tax return, please check the box below:

My income was such that I did not have to file a tax return.
By completing this application, which will serve as a statement of income, I am certifying that the information furnished regarding family size and taxable income is true to the best of my knowledge.

I agree to waive my rights under the Family Privacy (Buckley) Amendment, and agree to permit the Student Support Services Program staff to access my grades and academic history. I am providing written consent for the redisclosure of my Federal Tax Information by the Office of Financial aid to include Student Support Services and with my further express written consent obtained by an institution of higher education, the redisclosure of FAFSA information pursuant to the terms and conditions of 20 U.S.C. § 1098h(c). I understand this information will remain confidential and only utilized in determining eligibility and necessary services.
Student Signature (please use mouse or your finger to sign):*

Clear
Dependent Students: The parent(s)/guardian(s) on the FAFSA must be the parent(s)/guardian(s) who provides consent on this application.
Parent/Guardian #1 Name:*

First NameLast Name
Parent/Guardian #1 Signature*

Clear
Parent/Guardian #2 Name:

First NameLast Name
Parent/Guardian #2 Signature

Clear
If you have any questions about how to complete this application, please contact SSS at (828) 689-1138 or SSSTrio@mhu.edu.

SSS Services Agreement
Student Support Services is a federally-funded program designed to assist 165 eligible students at Mars Hill University who have need for academic, personal, and social support.

Program expectations:
1. Mature and grow as a student at Mars Hill University.
2. Treat everyone with respect.
3. Attend all classes and arrive on time.
4. Meet with assigned SSS advisor by appointment every two weeks or as scheduled.
5. Attend at least one workshop each semester.
6. Utilize all resources as recommended (including tutoring).
- l agree to abide by SSS program guidelines and regulations.
- I agree to participate in activities, events, and services offered by the SSS program.
- I understand that all SSS program services are provided without cost to me.
- I agree to abide by all expectations as set forth in this agreement.
Student signature *

Clear
Date

MonthDayYear
mm-dd-yyyy

MARS HILL UNIVERSITY

ELIGIBILITY INFORMATION

EDUCATIONAL BACKGROUND