Thank you for your interest in our Student Support Services program!  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 then return to submit your application.  If you have any questions, please call our office at (785) 826-2973.

All information will remain confidential and will be used for: A) eligibility determination, B) student demographic record keeping, C) needs assessment, D) federal reporting, E) other administrative purposes.

*required fields
Personal Information:
Last Name: *
First Name: *
Middle Name: *
Gender
Social Security Number: *
Date of Birth: *
Permanent Address: *
Permanent Address 2:
Permanent City: *
Permanent State: *
Permanent Zip: *
Cell Phone Number: *
Email Address: *
Ethnicity: *
Citizenship:
Income Eligibility:
Have you completed a FAFSA?
Are you or will you be receiving federal financial aid?
First Generation Eligibility: Please answer the following questions based on their education at the time you were living with them. 
What is the highest level of education completed by your MOTHER? *
What is the highest level of education completed by your FATHER? *
What is the highest level of education completed by your GUARDIAN?
Other Eligibility:
Would you like to declare a disability? (Physical, learning, mental or emotional) We do not need any formal documentation just a self-discloser.
Previous Education Information:
Do you currently hold a GED?
Do you currently hold an Associate's Degree?
Do you currently hold a Bachelor's Degree?
Are you a transfer student from another college/university?
Do you currently hold a high school diploma? *
What is your current major? *
Program Entry Grade Level *