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Student Support Services - Application

Please complete the following information.  Required fields are marked by an asterick.
Personal Data:
First Name:*      MI:      Last Name:*  
Gender:      Race:      Birthdate:
 
Campus Information:
Dorm Address:      Classification:
Status:      ACT Score:
 
Miailing Address:
Street/P.O. Box:*
City:*      State:*      Zip:*
 
Contact Information:
Phone:*      CellPhone:
Email:
 
Answer the questions below. A member of the Student Support Services Program staff will contact you if you are eligible and chosen to participate in this program.
 

Has either of your parents completed a 4-year college degree?

Do you have a documented physical disability?

Do you have a documented learning disability?

If you qualify for Student Support Services, would you like to be considered for this program?
 

Not everyone has an equal chance of graduating from college. The Student Support Services program at HCC is designed to make sure that eligible students increase their chances of graduating. Student Support Services can assist you by:

  • Assuring you get all the financial aid which you are entitled to.
  • Providing academic advising that takes into account your career goals and preparation.
  • Providing tutoring in courses in which you have difficulty
  • Providing career and personal counseling.
  • Providing transfer assistance to program Sophomores.

Check the services that you think could contribute to your success in college:    






To the best of my knowledge, the information I have provided is correct.