ELIGIBILITY APPLICATION

Thank you for your interest in our Student Support Services program here at Crowder-Nevada! We have so much to offer you as a TRIO SSS Student. Please complete this application as thoroughly as possible because you cannot save your progress during the application. If you cannot complete all the boxes/fields, that is perfectly OK! We will help you finish filling it in later. So if  you don't know the answer, just move on to the next question. The most critical questions we need answered are the ones about your name and contact information, and the ones about your income and if you are a first generation student.

You can call us for assistance at 417-667-0518, just ask for SSS!

Visit our webpage for more program information.
Last Name: *
First Name: *
Middle Name:
Date of Birth: *
Please select primary reason you would like to be in SSS from the drop down menu. If you need more than one of our services, that is great. We just want the primary reason for now. *
Address: *
Address 2:
City: *
State: *
Zip Code: *
Cell Phone Number
Home Phone (if different from cell #)
Personal Email Address:
Academic Info:
Current GPA:
Family Information:
Mom's Educational Level: *
Dad's Educational Level *
How many people in your household at home? *
I (Student/Applicant) am - *
PARENT(S) HOUSEHOLD INCOME (REQUIRED) If you are under the age of 24, please have your parent(s) enter their TOTAL "TAXABLE INCOME" from their most current tax return. (Parent will need to complete electronic signature at end of application also). Please enter "TAXABLE INCOME" only. Note: “TAXABLE INCOME” is usually much less than your “ADJUSTED GROSS INCOME,” so be sure you find the “TAXABLE INCOME” box for the amount.
STUDENT INCOME: If you (the student/applicant) filed taxes, please enter your TAXABLE INCOME (Line 15 on Form 1040) from your most recent tax return here. Please enter "TAXABLE INCOME" only.
Applicant (Student) Signature
Signature Type: Simple    Start Over
Click here to start signing.
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Signature: (Type in your full name)
I agree to the terms included.
Parent Signature here if Parent TAXABLE INCOME is submitted
Signature Type: Simple    Start Over
Click here to start signing.
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  • Reset
Signature: (Type in your full name)
I agree to the terms included.
Terms of Submission:
By submitting this application, you acknowledge that all of the above information is correct and accurate to the best of your understanding. You may also be required to physically sign the application upon your first visit to our offices to verify the information you provided.