SSS Online Application

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.
  • Disclaimer: The answers indicated in this survey will not affect your overall eligibility for admittance into the program
  • (304)696-3164 or