Thank you for your interest in our Student Support Services program at the University of Nebraska Lincoln!  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 402-472-2027

General Information:

Last Name: *
First Name: *
Middle Name:
Date of Birth: *
UNL ID Number (If you know it)
T shirt size (S, M, L, XL, XXL, XXXL)
Describe your primary reason for applying: *
Permanent Address: *
Address 2:
Permanent City: *
Permanent State: *
Permanent Zip Code: *
Local City
Local State
Local Address
Local Address 2
Local Zip
Home Phone
Cell Phone Number: *
Non UNL Email Address *
UNL Email Address: (if you have one)


Gender given at Birth *
Gender you identify with ?
Pronouns (He/Him, She/Her, They/Them)
Please Answer Yes or No to the following questions about ethnicity/race. 
Asian *
Black or African American *
American Indian or Alaskan Native *
Race, Hawaiian or other Native to Pacific Island *
Hispanic *
White *
SA Ethnicity *
Residency *
Are you a Nebraska Resident? *

Academic Info:
Current Grade Level at UNL:
Current GPA:
If Major is not listed please type here
How's your academic standing?
ACT Composite Score
ACT English Score
ACT Math Score
ACT Reading Score
ACT Science Score
SAT Combined Score

Program Information: 
Check all programs you have been in or currently in:
Regular Upward Bound
Upward Bound Math and Science
Student Support Services (SSS from a different College)
McNair Scholars
Educational Talent Search
Nebraska College Preparatory Academy (NCPA)
McNair Program
Check all that apply for the type of programs or services you are interested in? 
Writing Assistance
Personal Counseling
Student Advisory Board
Financial Aid/Scholarships
FYRE (Undergraduate Research Opportunity)
Study Skills
Financial Literacy
Laptop or Calculator Checkout
Graduate School Preparation
Mentoring Program
Individual Tutoring
Printing Services
Academic Advising
Math Tutoring Lab
Career Counseling/Resumes
Please list any clubs or organizations you are interested in joining at UNL

Check any SSS courses you are interested in taking? (SSS courses are designed to be smaller 20-25 students per class)

ENGL 151 (Rhetoric as Argument)
BIOS 101 (General Biology)
UGEP (First Year Seminar)
ALEC 102 (Interpersonal Skills for Leadership)
Life Science 120
ENGL 150 (Writing Rhetoric)
Math 104 (Applied Calculus)
Math 101 (College Algebra)
Math 100A (intermediate Algebra)
List any classes you may need tutoring for. If unsure you can type in just the subject matter (Math, Science, English).

Program Eligibility 
Do you have a documented physical/learning disability?
If Yes, is your disability on the file with UNL Services for Students with Disabilities (SSD) office?
Did either of your parents graduate from a four-year college?
Did you apply for Financial Aid?
If Yes, did you receive a Pell Grant as part of your financial aid package?
Do you qualify for the Nebraska Promise? (
Sign and Submit:

Certification Statement

I hereby give the Student Support Services TRIO Scholars Program my permission to

  • Examine my financial aid information in order to determine my eligibility for the SSS program
  • Access my educational record and other relevant information in order to access the services to be provided, and to evaluate my academic progress 

If selected to participate in the SSS Program, I will actively strive to fulfill my potential as a student committing myself to the pursuit of a baccalaureate degree.

Applicant Signature *
Please select a signature verification type.