Student Support Services Application

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Student Support Services will use your Henderson State University email address, your local phone number and current Henderson State mailing address to correspond with students. It is the responsibility of each student to check his or her university email and local mail box. It is also the student's responsibility to maintain contact with Student Support Services to learn of activities.

Last Name *

First Name *

Middle Name

Maiden Name

Student Identification Number

Date of Birth (MM/DD/YYYY) *

Ethnic Group

American Indian/ Alaskan Native

Asian

Black/African American

Hispanic/Latino

White/European

Native Hawaiian/Pacific Islander

Other

Clear selection

If other race, please specify, are you an American citizen?

Yes

Clear selection

If not, please provide your alien number.

Cell Number

Henderson State University Email Address *

Home Mailing Address

Home Phone Number

Have you ever been in the care of a state foster care system?

Yes

Clear selection

Is English your first language?

Yes

Clear selection

If no, what other languages are spoken in your home?

Are you a commuter student?

Yes

Clear selection

If you have been out of school for five or more years, please tell us what you've been doing.

Henderson State classification:

Freshman

Sophmore

Junior

Senior

Clear selection

College major

Interested in attending graduate school?

Yes

Maybe

Clear selection

If you are a transfer student, please list the college or university you attended

Do you already have a four-year college degree?

Yes

Clear selection

Are you a full-time student, taking 12 or more hours per semester?

Yes

Clear selection

Do either of your parents have a four-year college degree?

Yes

Clear selection

Do either of your parents have a two-year college degree?

Yes

Clear selection

Do you receive financial aid?

Yes

Clear selection

Do you have a documented disability?

Yes

Clear selection

If so what is your disability?

Have you ever received services from the Henderson State Disability Resource Center?

Yes

Clear selection

Have you participated in TRIO programs like Veterans Upward Bound, Talent Search, etc.?

Yes

Clear selection

If so, where?

Student Support Services needed

Academic tutoring

Advice and assistance in course selection

Education and counseling to improve financial and economic literacy

Information on applying for federal financial aid

Assistance in applying graduate school and obtaining financial aid

Workshops and nontraditional support group

Equipment checkout

Computer instruction

Cultural activities

Career exploration

Volunteer opportunites

Office equipment an lab use

Employment as a tutor (you must have one semester at Henderson and meet job requirements)

Instruction on how to use my email account or how to use my student account

Help with skills needed for online courses

Help with software such as MS Word, Excel, PowerPoint, Publisher

Write a statement about yourself.

Submit

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