K-State Salina TRIO - SSS Application

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. 

Please review the required information and take some time to make notes and gather the required documents, and then return to submit your application. 

Required information:

  • 2024 Family's taxable income
    •  Line 15 on tax form 1040
  • Number of people in household
  • Parent's signature
  • Parent(s) or Guardian(s) educational level.
  • Two short answer questions
  • Student's Signature

If your SSS application does not submit:

  • Make sure all required fields are submitted.  The items not submitted will be listed in red after you click the submit button.
  • If you use the signature pad option for your signature, Click the Sign and Submit button.  Type in your name.
  • Check the I agree to the terms included" checkbox
  • The system times out after 20 minutes, which may lead to an application submission error. If this occurs, you will have to fill out the application again.

When the application is successfully submitted, you will receive a message about thanking you for applying with the option to send an email confirmation.

If you have any questions, please email kstatesalinasss@gmail.com, call 785-519-2637 or come by our office at College Center 209.

 

General Information
First Name *
Middle Name
Last Name *
Chosen Name

 
Date of Birth *
Are you an US Citizen or Permanent Resident? *

 

 
Gender *

 
Race, Hispanic *
Race, American Indian or Alaskan Native *
Race, Asian *
Race, Hawaiian or other Native to Pacific Island *
Race, Black or African American *
Race, White *

 
What previous education do you have? *
What grade level are you at in school? *

 

Electronic Contact Information:
Cell Phone Number *
KSU Email Address *
Alternative Email Address:

 

Permanent Address
Permanent Address *
Permanent Address 2
Permanent City *
Permanent State *
Permanent Zip *

 

Local Address:  Leave blank if unknown.

If you live off campus, enter your complete address.

If you live in the Residence Halls,
enter your Residence Hall name and room number in the second address line
Local address
Residence Hall and Room #
Local City
Local State
Local Zip

 

 

Eligibility Criteria

The following information is used to determine eligibility for SSS. Please read carefully!

 

ALL SECTIONS MUST BE COMPLETED AND SIGNED!

Income Status:

The SSS program offers scholarships based on income eligibility so we will need a bit of income information.

If you are a Dependent please provide us with your guardian's email address so we can send them our Income Eligibility Criteria Form. 

If you are an Independent please provide us with your email address we can you our Income Eligibility Criteria Form.
Email Address to send the Income Form: *

 
Do you reside with
Do you (the student) have children?
Are you an independent student according to Financial Aid? If so, you can sign in the parent signature block.
Have you applied to Financial Aid

 

First Generation Status

Indicate the highest level of education that your parent(s)/guardian (s) has earned.

Parent or Guardian 1 *
Parent or Guardian 2 *

 

Learning, Psychiatric, or Physical Disability

You may qualify for SSS if you have a medical, physical, sensory, cognitive, psychiatric, or brain related condition.

If you need help getting connected with the Student Access Center to get your accommodations, please let us know and we can help!

For more information, contact Student Access Center  

785-532-6441

 accesscenter@ksu.edu

Office Information
Do you have a diagnosed learning, physical or psychiatric disability? *
Have you provided the expected kind of documentation to the Student Access Center? *

 

 
All the information provided on this page is true to the best of my knowledge. *

 

 

Commitment to Participate

 

If accepted into the Student Support Services Program, I agree to the following:

  • I will meet with SSS regularly each semester.

  • I will attend SSS Events or workshops each semester (academic, financial literacy, retreats, cultural).

  • I will attend all classes and complete coursework in a timely manner and participate in the tutoring program as needed throughout the academic year.

 

 

 

Release of Information Consent

 

I hereby authorize the Student Support Services staff to access my academic records and to request attendance and performance information from my instructors on my behalf.

I hereby authorize my instructors to release such information. I release the staff of Student Support Services and my instructors from all legal responsibility or liability that may arise from the actions I have authorized.

I give my consent for Kansas State University Salina Student Support Services program to use my photo and provide information on my participation in the SSS program in the SSS website, Facebook page, brochures and newsletters. This agreement remains in effect during my years as a student at KSU Salina.

Furthermore, I understand that by applying for the TRIO Student Support Services Program, I authorize the program staff to obtain records or data pertinent to my participation from other sources, and to release information as required by law or the terms of the Student Support Services grant, to the grant funding agency of the United States government.

The Student Support Services Program staff has my permission to communicate verbally and otherwise with staff,
faculty, and/or off campus professionals on my behalf.

 

 
Student Signature *
Please select a signature verification type.
Date *

 

 

Student Support Services is funded by the U.S Department of Education.

Acceptance into the program is contingent upon meeting eligibility criteria and space availability.

 

 Terms of Submission:

By submitting this application, I acknowledge that all of the above information is correct and accurate to the best of your understanding.