Northeastern State University

Student Support Services

Thank you for your interest in Student Support Services! If you have any questions, please call Student Support Services at 918/444-3035.

General Information:

First Name: *

Middle Name (if none, put n/a)

Last Name: *

NSU Student ID Number: *

Date of Birth: *

Gender *

Live On Campus or Off Campus

Permanent Address *

Permanent City *

Permanent State *

Permanent Zip *

NSU Email Address *

Marital Status *

Are you a U.S. citizen? *

Cell Phone Number *

Ethnicity/Race

(Mark all that apply):

Asian

Black/African American

Hawaiian/Pacific Islander

White

American Indian/ Alaskan Native

Hispanic/Latino

Eligibility:

Has either parent completed a four year bachelor's degree, with whom you grew up, prior to the age of 18? *

Do you have a documented disability? (Registared with the ADA Office on campus)

Are you a veteran of the U.S, armed forces?

Financial Aid Information

Do you Receive Pell Grant? *

Did you complete the 25/26 FAFSA? *

Ever been on academic/financial aid probation or suspension? *

Educational Information:

Have you received your high school diploma or GED? *

Are you a Transfer Student?

What is your current classification?

Diploma Date (Mo/YR)

Attended college before/earned college credit? *

Intended Major/Career *

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:

Tutoring Services

Mentoring Services

Academic Advice/Course Selection

Undecided Major/Career Assessment

Financial Aid/FAFSA Assistance

Financial Education (scholarships/budgeting)

Cultural Enriching Activities and/or Events

Academic Workshops

Personal Counseling

Release of Information

I grant SSS permission to use my photograph in program-related materials, including but not limited to social media platforms, brochures, and flyers.

By signing this application, I certify that the information provided to NSU Student Support Services (SSS) is true and accurate to the best of my knowledge. I hereby authorize SSS to obtain copies of my educational records and any other related materials necessary for my participation in the program, both at present and at any time in the future.

Sign and Submit:

Applicant's Signature *

Please select a signature verification type.