Northwestern Oklahoma State University Horse and Rider graphic
  • Logo for TRIO support services

  • CONFIDENTIAL APPLICATION

  • STUDENT INFORMATION

  • Format: (000) 000-0000.
  • WHICH BEST DESCRIBES YOU:*
  • Format: (000) 000-0000.
  • DATE OF BIRTH (MONTH/DATE/YEAR):*
     - -
  • TODAY'S DATE*
     - -

  • EDUCATIONAL INFORMATION:

  • Year In College:*
  • What is your educational goal (mark all that apply)?*
  • DO YOU IDENTIFY AS HISPANIC OR LATINO:*
  • What is your race?*

  • CITIZENSHIP STATUS:

  • Citizenship Status options*

  • FOSTER CARE/HOMELESS STATUS

  • Foster Care/Homeless Status options

  • ELIGIBILITY CATEGORIES

  • FIRST GENERATION ELIGIBILITY

  • Did your father/guardian receive a 4-year college degree?*
  • Did your mother/guardian receive a 4-year college degree?*

  • DISABILITY STATUS

  • Do you have a disability that is eligible for accommodations?*
  • Do you have your 504, IEP, or a doctor's note?*
  • Have you applied for accommodations based on your disabling condition at NWOSU?*

  • INCOME ELIGIBILITY

  • Did you file FAFSA as an INDEPENDENT student?*
  • Did you file FAFSA as a DEPENDENT student?*
  • I need help determining my FAFSA status*
  • Are you receiving a Pell Grant or FESOG?*
  • Student Support Services is 100% federally funded.
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  • ACADEMIC NEED: PLEASE SELECT AS MANY AS YOU NEED

  • ACADEMIC ASSISTANCE
  • FINANCIAL STRATEGIES
  • AFTER NORTHWESTERN
  • ADVISING
  • RESOURCE NEEDS
  • SUPPORT NEEDS

  • WE REQUIRE THE FOLLOWING COMMITMENT FROM YOU:

  • I WILL meet with my SSS advisor at least weekly during my first two semesters and monthly thereafter.*
  • By checking the items above in My Academic Plan, I agree to the program commitments and requirements shown by my signature below.
  • Date:*
     - -
  • Date:
     - -

  • I grant permission to Student Support Services to track all of my academic progress at NWOSU and communicate with my parents/ guardians. I hereby authorize the release of my student academic and financial aid records for the SSS professional staff to use to discuss with me and if appropriate my instructor in order to better assess my academic progress. I understand that my instructors may be contacted during the semester to evaluate my class progress. These evaluations will be available to me upon my request. In addi- tion, I hereby give my permission for my photograph, work and/or statements to be used by Student Support Services for promotional, or publicity purposes. If found eligible for SSS, I agree to actively participate in the program, and I certify that the information provided by me is correct to the best of my knowledge.
    Privacy Act: In accordance with the Privacy Act of 1974 (Public Law No. 93-579, 5 U.S.C. 552a), you are hereby notified that the Department of Education is authorized to collect information to implement the Student Support Services Program under Title IV of the Higher Education Act of 1965, as amended (Pub. Law 102-325, Sec. 402D). In accordance with this authority, the Department  receives and maintains personal information on participants in the Student Support Services program. The principal purpose for collecting this information is to administer the program, including tracking and evaluating participant progress. Providing the information on this form, including a social security number (SSN) is voluntary; failure to disclose a SSN will not result in the denial of any right, benefit or privilege to which the participant is entitled. The information that is collected on this form will be retained in the program files and may be released to other Department officials in the performance of their official duties.

  • Student Support Services is 100% federally funded.

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  • CONFIDENTIAL INCOME VERIFICATION

  • IMPORTANT: If you filed the FAFSA as an INDEPENDENT student, that is you did not file the FAFSA using your parents' taxes, disregard parent signature.
    If you filed the FAFSA as a DEPENDENT student, that is you filed the FAFSA using your parents' taxes, fill out all sections based on parents' information.
    Please use the Household and Taxable income that was listed on your FAFSA.
  • Include yourself, your spouse, your children and any other individual who is receiving more than half of their support from you.

  • CONFIDENTIAL TAXABLE INCOME STATEMENT

  • The other part of determining your eligibility is taxable income. This is from the income tax form that you used for FAFSA. Typically this is found on line 15. Enter $0 if you are a homeless student or a former foster child.

  • CERTIFICATION

  • I certify that the information submitted on this form is accurate to the best of my knowledge.
  • DATE:*
     - -

  • If you did not file taxes in either of the last two years or your tax return is not available, contact the NWOSU TRIO Student Support Services office (580-327-8120) by email trio-sss@nwosu.edu for further assistance.
    Family taxable income information is required by federal regulations for participation in a Student Support Services program.
    We will apply the information you provide and use a chart provided by the Department of Education to determine your eligibility. Your information is handled in a strictly confidential manner.

    If you have issues, please call (580)327-8120.

  • Student Support Services is 100% federally funded.
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