2022-2023 Student Support Services Application

Thank you for your interest in NCMC's Student Support Services program! Please complete this application as thoroughly as possible. You cannot save and restart this application.  You may want to review the included items, take some time to make notes and gather the required documents, and then return to submit your application.  If you have any questions, please call our office at (660) 357-6332. 
General Information:
Last Name: *
First Name: *
Middle Name:
Gender: *
Gender or sex assigned at birth; required only for reporting purposes to the U.S. Department of Education
Date of Birth: *
School ID
Marital Status *
Address: *
Address 2:
City: *
State: *
Zip Code: *
Cell Phone *
Social Security Number *
Email Address: *
Academic Info:
Please select the option that applies.
What year did you obtain your Diploma/GED?
How many credits do you currently have? *
Current GPA: *
How's your academic standing? *
African American
American Indian or Alaskan Native
Native Hawaiian or Other Pacific Islander
Are you of Hispanic or Latino descent? *
Citizenship/Program Information: 
Are you an orphan, are (were) you (until age 18) a ward/dependent of the court? *
Are you are US Citizen/Permanent Resident? *
Are you a veteran? *
Were you in Upward Bound or Talent Search? *
Have you ever been served by SSS at NCMC or another institution? *
Do you have a physical or documented disability which requires special accommodations to help serve you academically? *
Have you applied for Accessibility Services at NCMC?
How did you hear about us? *
Education/Career Goals:
Degree sought at NCMC: *
Will you transfer to another college? *
Are you unsure about your career or academic goals? *
Possible area's of academic/career Interest
What area of need do you need or want assistance? *
What concerns do you have when it comes to pursuing your education? How can we provide you assistance? *
List any additional areas of need here.
Parent 1 Educational Level: *
Parent 2 Educational Level: *
How many people are in your household at home? *
** 2021 Taxable Income: (Independent Students Only; Found on line 15 of your 1040 Tax Return)
Have you applied for Financial Aid for the current academic year (FAFSA completed for 2022-2023)? *
Did you receive Financial Aid? *
What Financial Aid did you receive?
Pell Grants
Voc Rehab
** Most Recent IRS 1040 (Optional)
Sign and Submit:
Applicant Signature *
Signature Type: Simple    Start Over
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Signature: (Type in your full name)
I agree to the terms included.
According to Student Support Services CFR Part 646.7: First Generation College Student means: 
 [1] A student neither of whose natural or adoptive parents received a baccalaureate degree; 
 [2] A student who, prior to the age of 18, regularly resided with and received support from only one parent and whose supporting parent did not receive a baccalaureate degree; or 
 [3] An individual who, prior to the age of 18, did not regularly reside with or receive support from a natural or adoptive parent.
According to the above defintion, the following is true to the best of my knowledge: *
Terms of Submission:
I understand that Student Support Services will use the data provided on this form to assist in assessing my academic and/or career planning needs and that all of the information will be kept confidential. I release the following information to SSS staff: high school transcripts, SAT/ACT/COMPASS/ACCUPLACER/Nelson Denny scores, instructor evaluations, financial assistance award notices and income information, vocational rehabilitation records, disability services records and any other information from my academic records pertaining to my enrollment in SSS. I understand that my Social Security Number (SSN) is collected only for use in verifying enrollment at transfer schools via National Student Clearinghouse. I certify that the information on this application is true and correct to the best of my knowledge. 

**“Independent” according to FAFSA: Less than 24 years old, married, veteran/active duty military, have legal dependents, orphan or ward of the court, emancipated minor, homeless/risk of becoming homeless, or have some other established special circumstance. 

**Dependent Students: Complete the Dependent Verification Form (Found on SSS's website and Facebook page) if you provided parent financial information on your FAFSA—see SSS staff for more information. This form must be filled out by a parent or guardian.