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Application for Services
Student Support Services is a federal grant program funded by the U.S. Department of Education. It provides a number of specific services important to your success at the university. You may be eligible for this program. Please fill out this application form. We will verify your eligibility and let you know if you are selected to be one of the 180 participants selected to participate in this grant program.
First Name: Middle Name: Last Name:
Student ID: E-mail Address:
Please answer the following questions:
Have you previously participated in: Student Support Services, Upward Bound, Educational Opportunity Center, Talent Search or the McNair Program? YES NO
Did either of your parents, natural or adoptive, with whom you last resided, receive a bachelor's (4-year college) degree? YES NO
How committed are you to leaving this institution with a B.A. degree? Very Somewhat Not too committed
Are you a U.S. citizen? YES NO
Are you a resident alien? If so, please provide alien registration number. YES NO
What extracurricular activities were you involved in during high school? Check all that apply. Church
Music
Organiations
Volunteer activities
Sports
Other
How well do you think you'll do in college? 1 Lowest
2
3
4
5 Highest
In what areas do you believe you'll need the most assistance? Check all that apply. Academic planning
Attendance
Choosing a major
Computer training
Homework
Personal Counseling
Study skills
Test preparation
Tutoring
Other
If eligible and selected for participation in the Student Support Services program, I agree to maintain regular contact with program staff and actively participate in the activities and/or services specified by the Student Support Services Program as needed and recommended by the staff.
Signature: Date:
Graceland University - 
Lamoni Campus | 1 University Place | Lamoni, IA 50140 | 641.784.5000
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