Northeastern State University
Student Support Services
705 N. Grand Ave.
Tahlequah, OK, 74464

Thank you for your interest in Student Support Services! 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 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
Marital Status
Live On Campus or Off Campus
Permanent Address *
Permanent City *
Permanent State *
Permanent Zip *
NSU Email Address *
Cell Phone Number *
Did you participate in a TRIO program? (Talent Search, Gear Up, Upward Bound or Other) *
Where or from whom did you hear about this program? *
Ethnicity:
Are you of Hispanic descent? *
Race (Mark all that apply):
American Indian/Alaskan Native *
Asian *
Black or African American *
Hawaiian/Native to Pacific Island *
White *
Eligibility:
Are you a U.S. Citizen or permanent resident? *
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? *
Are you registered with the Office of Disability Services at NSU?
Have you submitted your FAFSA application? *

Educational Information:
Have you received your high school diploma or GED? *
Diploma Date (Mo/YR)
Attended college before/earned college credit? *
Ever been on academic/financial aid probation or suspension? *
All online student? *
Do you have a college degree? *
Advisor's Name
Intended Major/Career *
What is your educational goal?
Bachelor's Degree
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

Income Verification:

As a federally funded TRIO program, Student Support Services 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 31, 1999? *
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? *
Are you homeless or self-supporting or at risk of being homeless? *
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) 2022 Federal Income Tax Return, OR
  • Provide a parent/guardian's name and e-mail address below. By providing their e-mail address, you are giving SSS consent to contact to request financial documentation and provide e-signature as needed. OR
  • A document with the statement: "I certify that my parent's TAXABLE INCOME from all sources in the previous tax year of 2022 was $_________ with a family size of ____ (include yourself, 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 2022 IRS 1040 form line 15.) Photos are acceptable.
Parent/Guardian's Name:
Parent/Guardian's E-mail:

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

  • A signed copy of your 2022 Federal Income Tax Return, OR
  • A document with the statement: "I certify that my TAXABLE INCOME from all sources in the previous tax year of 2021 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 2021 IRS 1040 form line 15.) Photos are acceptable. OR
  • If no financial document is attached, you will be sent an E-Sign document to your NSU e-mail. You will need your taxable income and # of dependents.

If you or your parent/guardian(s) did not file taxes or you have questions concerning this section, please submit your application and contact our office at 918.444.3035.
Upload 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 information 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.

Notice of Non-discrimination: Northeastern State University Student Support Services is 100% federally funded at a cost of $343,649 and does not discriminate on the basis of age, race, color, religion, sex, sexual orientation, genetic information, gender identity or expression, national origin, disability, protected veteran status, or other protected category, in any of its policies, practices, or procedures. This provision includes, but is not limited to, admissions, employment, financial aid, and educational services.

Sign and Submit:
Applicant's Signature *
Please select a signature verification type.