Student Support Services Application

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

SSS offers participants advising, degree planning, tutoring, and assistance with transferring services. All services are free. To be eligible for the SSS program, students must have a need for assistance, meet federal economic guidelines, be a first generation college student, and/or have a documented disability. Participants must be U.S. citizens or permanent residents enrolled or accepted for enrollment at NW-SCC. Verification of taxable income is required.

NON-DISCRIMINATION POLICY – It is the policy of Northwest-Shoals Community College not to discriminate on the basis of age, color, creed, disability, national origin, race, religion, or sex in accordance with all laws, including Title IX of Education Amendments of 1972, Title VII of the Civil Rights Act of 1964, Sections 503 and 504 of the Rehabilitation Act of 1973, Americans with Disabilities Act, Civil Rights Act of 1991, and Executive Order 112346.

SEXUAL HARASSMENT POLICY – The College administration will take all necessary steps to insure that sexual harassment, in either the hostile environment or “quid pro quo” forms, does not occur on campus or at any event/activity sponsored by this College. This policy applies to all members of the College community. Students of the College community are encouraged to report complaints about sexual harassment to the Title IX Coordinator, Dr. Crystal Reed at 256-331-5291.

Student ID Number/"A Number" *

Last Name *

First Name *

Middle Initial

Have you attended NW-SCC under a different name? If yes, please provide previous name(s) *

Local Address *

Local City *

Local State *

Local Zip *

Email Address *

Cell Phone Number *

Please choose your home campus *

Preferred Method of Contact *

Gender *

Birthdate *

Are you a US citizen? *

Are you a permanent resident? *

Did either of your parents graduate from a four-year college? *

Are you a high school/GED graduate? *

What year did you graduate from high school or with your GED? *

Are you Hispanic/Latino? *

Race, Black or African American *

Race, American Indian or Alaskan Native *

Race, Asian *

Race, Hawaiian or other Native to Pacific Island *

Race, White *

Ethnicity and Race Information: Please select as applicable to you.

Who claims you as a dependent on federal income taxes? *

Have you completed the FAFSA? *

Will you be receiving financial aid? *

What type of financial aid will you be receiving? *

Do you have a disability documented through the NW-SCC ADA Office? *

Have you previously participated in Student Support Services?

Have you received a degree or certificate from NW-SCC? *

Have you earned a four-year college degree? *

Do you need assistance developing educational and or career goals? *

Would you like to receive tutoring from SSS? *

Have you been out of school for five years or more? *

Do you have low or failing grades in one or more courses? *

Do you need assistance selecting and registering for classes?

If you plan to transfer to another college or university, where do you plan to go? *

What is your planned major? *

*By submitting this application, I acknowledge the information provided in this application is accurate and complete to the best of my knowledge. Student Support Services personnel may have access to my NW-SCC Admissions, Financial Aid, and Academic records. I will provide official confirmation of my income and parents’ or guardians’ income. I also give permission for my name, photograph, and/or statements to be used in any media concerning SSS. If accepted, I agree to cooperate and participate as scheduled in the Student Support Services project. Failure to meet the requirements can result in dismissal from this program.

Please Provide Your E-Signature Below *

Please select a signature verification type.