Applying to SSS

STUDENT SUPPORT SERVICES + FTSP PROGRAM APPLICATION

First and Last Name *

First

Last

Personal Email *

Mailing Address *

City *

State *

ZIP *

Cellphone *

Are You an Independent Student (Yes/No)? *

Yes No

Ethnicity (please select the one that best applies to you) *

Choose One *

Male Female

Are you a U.S. Citizen? *

Yes No

Birthday-Month *

Birthday-Day *

Birthday-Year *

Did either of your parents/guardians graduate with a four-year college degree? *

Yes No I don't know I am an independent student

High School Name *

High School City *

High School State *

Prospective Major at Siena Heights *

Are you thinking of going on to graduate school? *

Yes No Unsure at this time

Do you plan on staying at Siena Heights until you graduate? *

Yes No

Do you have a documented disability? *

Yes No I don't know, but would like to discuss this with someone privately.

If you do have a documented disability, is this on file with the Siena Heights Office of Accessibility? *

Yes No Does not apply to me

Are you playing a sport at SHU? *

Yes No

If you are playing a sport, which one? *

Are you or will you be involved in any student organizations (e.g. Band, Theatre)? *

Will you be living on campus or commuting? *

On campus resident Commuting

Are you also applying for the FTSP Program? *

Yes No

Why are you applying for the FTSP program and/or SSS? In a short essay of 4-5 sentences, what do you hope to get out of the program? *

By submitting this application, I certify that any information which I have provided is true and correct to the best of my knowledge. I understand that information on this application will be used by the SSS Staff to assist in developing my academic, personal or other relevant needs, and I authorize the Student Support Services program staff to obtain any and all information and documentation necessary for processing and for ongoing evaluation of these needs in the pursuit of my degree at Siena Heights University. I understand that not meeting expectations of the program staff may result in the suspension of program privileges and/or termination from the SSS Program. I also give my consent for Student Support Services, and by extension Siena Heights University, to use my photograph and likeness in its publications, including its website. I release them from any expectation of confidentiality for myself and attest that I am the person listed above. *

Yes, I Agree

Submit Your Application!

SSS Online Application

APPLICATION INSTRUCTIONS

STUDENT SUPPORT SERVICES + FTSP PROGRAM APPLICATION