Project Stay Application for Admission

Project Stay Application

First Name *

Middle Initial *

Last Name *

Student ID # (With the S) *

Local Address *

Local City *

Local State *

Local Zip *

Do you live on campus (Yes/No) *

Phone Number *

Campus Email Address (@mymail.mssu.edu) *

Date of Birth *

Are you 25 or Older? *

Legal Sex/Gender Assigned at Birth *

Gender Identity, If Applicable

Chosen Pronouns/Name (if other)

Marital Status (Married or Single) *

Race, American Indian or Alaskan Native *

Race, Asian *

Race, Black or African American *

Race, Hawaiian or other Native to Pacific Island *

Race, Hispanic *

Race, White *

Ethnicity *

U.S Citizen or Permanent Resident?

Has your Parent(s)/Guardian(s) completed a Bachelor's Degree or higher? (Yes/No) *

If Yes, What Degree level? (Bachelor's/Master's/Doctorate)

Do you receive accommodations for a disability through the Student Success Center? *

Are you currently enrolled in classes? *

How many hours are you currently enrolled in?

Which High School did you graduate from? (If GED enter "GED") *

Did you receive a Diploma or GED? *

What year did you graduate high school or receive your GED? *

Current College Grade Level (COMPLETED Hours) *

Is this your first semester at MSSU? *

Are you a transfer student at MSSU? *

Who is your Academic Advisor?

What is your Major? (If undecided, type "undeclared") *

What is your minor?

Are you employed? *

If employed, how many hours do you work per week?

Have you been a participant in a TRIO Program before? (This includes Upward Bound, Educational Talent Search, and Student Support Services *

Are you a Single Parent *

Have you previously completed a Bachelor's (4-year) degree?

What degree are you currently pursuing at MSSU? *

What is your anticipated graduation year? *

Do you plan on transferring to a different school? *

Are you recognized as an Independent Student by the financial aid office? *

Please select ALL of the Project Stay services you are interested in using:

Academic Advising

Tutoring

Study Skills Development

Financial Literacy Development

Career Counseling/Job Shadowing

Leadership & Professional Development class

Assistance with graduate school admission

Assistance with financial aid/scholarship applications

Workshops/on campus cultural events

Priority Enrollment

Free Printing

Grant Aid (priority given to students with fewer than 60 hours - limited awards)

Are you a Student Athlete? *

Are you a veteran/active military? *

What is the highest level of education of Parent/Guardian 1 *

What is the highest level of education of Parent/Guardian 2 *

Do you receive Federal Pell Grant? *

What is your educational goal, and how will being a part of the project stay program benefit you in reaching your goal? (please answer thoughtfully - this information will be considered when we select students for the program.) *

How did you hear about Project Stay?

By signing this form, you are verifying to MSSU Project Stay and U.S. Department of Education that the information contained in this application is true to the best of your knowledge.

If selected for Project Stay I understand that I am expected to satisfactorily maintain a grade point average of 2.2 or above, participate in Project events, and work closely with my Project advisor to accomplish my educational goals. I understand that Project Stay staff may consult my current instructors to collect information about my class attendance and class work completion. I agree to permit Project Stay staff access to my grade reports, financial aid documentation, and other confidential records necessary for program documentation and evaluation. If grade point average falls below 2.2, or I do not participate, I may be removed from the program.

IMPORTANT: Project Stay cannot process your application without your Social Security Number and S number. Project Stay also may not process incomplete applications. I give permission for Project Stay to contact me through phone, text, email, and/or various social media.

Signature *

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Signature: (Type in your full name)

I agree to the terms included.

Date of Signature *

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