TRIO STUDENT SUPPORT SERVICES APPLICATION

Thank you for your interest in our Student Support Services program. Please complete this application as thoroughly as possible. You must complete this application from start to finish in one session as such, you may want to review the form, take some time to gather the required documents, and then return to submit your application. If you have any questions, please call our office at: 402-354-7073 or send an email to Lisa: lisa.johnson2@methodistcollege.edu or Kristin: Kristin.loewe@methodistcollege.edu

Thank you!

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General Information

First Name *

Last Name *

Date of Birth *

Name you’d like to be called

Student ID number *

Permanent Address line 1: *

City *

State *

Zip Code *

Cell Phone Number *

School Email Address *

Personal Email (optional)

Gender assigned at birth *

Preferred pronouns

Marital status *

Race, American Indian or Alaskan Native *

Race, Asian *

Race, Black or African American *

Race, Hawaiian or other Native to Pacific Island *

Race, Hispanic *

Race, White *

SA Ethnicity-primary *

Primary Language *

What other languages do you fluently speak other than English

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Eligibility Criteria

Are you a U.S. citizen, permanent resident and/or eligible to receive federal financial aid? *

Highest level of education obtained by mother/female guardian *

Highest level of education obtained by your father/male guardian *

Were you ever in foster care? *

During your childhood, with whom did you live the most? (ex. both parents, just mom, grandparents)? *

What are your current living arrangements?

What is YOUR parental status

Do you plan to complete a bachelors degree program at NMC? *

Have you previously earned a bachelors degree? *

What is your enrollment status at NMC? *

In what program are you enrolled? *

Have you previously participated in a TRIO program in the past?

Do you identify as an individual with a disability, or receive accommodations from our ADA office on campus? An individual with a disability is defined by the ADA as a person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment. *

How did you learn about the TRIO SSS program?

Select an item that represents your greatest need for support from our TRIO SSS program. You will have the chance to identify other needs in the next question. *

In this space, provide additional details about any of your greatest needs or challenges. *

Why do you want to be a part of the TRIO Student Support Services program? How can our staff help you address some of your challenges? *

Number of people in household

Family Income Range

Please upload most recent 1040 tax document if available

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By typing my name, I signify that the information I provided here is true to the best of my knowledge *

Today’s date *

After submitting this application, a staff member with reach out to you within one week to schedule an eligibility interview. During that visit you will be asked to verify taxable income with a signature as part of our application process.

Thank you for your interest in our program!