Please fill out the following information. We will then contact you once we have received your application. If you are unable to submit the application, click HERE to download a digital copy of the form. The form can be saved and emailed to

Student Support Services Online Application

  • Because Student Support Services is a federally funded program, the following personal data questions are asked for statistical purposes only. None of the information will be used for determining your eligibility to participate in the program.
  • Read the following description. Type your signature and today's date to demonstrate understanding of the following statement.
  • (304)696-3164 or