SSSP Application

THE STUDENT SYNE SERVICES PROGRAM
Student Support Services educational opportunity
program, funded by the U.S. Department of Education,
It is housed under the Division of Enrollment Management by Voorhees College in Denmark,
South Carolina.
To qualify, a traditional or non-traditional student must
1. Need academic support to achieve a goal of graduating from college;
2. Be a U. S. citizen or national:
3. Be enrolled full-time at Voorhees College and
4. Meet one or more of the following criteria:
• Neither parent graduated from college with a baccalaureate degree
• Have a physical or learning disability that requires accommodations to
the learning environment
•Family meets established income criteria

Step 1 of 6

Name(Required)

First Middle Last

Email(Required)

Enter Email Confirm Email

Birth Date(Required)

Name of Dorn(Required)

Off-Campus Address(Required)

Street Address Address Line 2 City State ZIP Code

Cell Phone(Required)

Permanent (Home) Address:(Required)

Street Address Address Line 2 City State ZIP Code

CHECK ONE IN EACH CATEGORY:

Gender:

Academic Level:

Ethnicity:

Are you a U.S. Citizen?

Marital Status:

Has either of your parents/guardians received a Bachelor's Degree?

Do you currently reside with at-least one parent?

Do your parent(s) have a Bachelor's Degree?

Which parent(s) do you reside with?

Are you an independent student?

8. Total number of people living in your house (include yourself).

Your father's name:

First Last

Is your father living or deceased?

Your mother's name:

First Last

Is your mother living or deceased?

Do you live on a farm?

What is the combined yearly income in your house

Are you an individual with a disability?

Which requires special accommodations extended time on tests, note-taking/er, etc.

Please, state your learning or physical disability.

Medical Contact Information

How did you hear about Student Support Services?

Name of Health Insurance Provider:

Insurance Policy #:

Insurance Medicaid #:

Doctor's Name:

First Last

Doctor's Phone #:

In Case of An Emergency Contact

Contact #1's Name:

First Last

Relation

Phone

Address

Street Address Address Line 2 City State ZIP Code

Contact #2's Name:

First Last

Relation

Phone

Address

Street Address Address Line 2 City State ZIP Code

Your Driver's License or State ID#

Please include the state that it is registered to.

1897 Voorhees Road, Denmark, SC 29042
Phone (803) 780-1234 | Toll Free (866) 685-9904

Voorhees University is accredited by the Southern Association of Colleges and Schools Commission on Colleges (SACSCOC) to award baccalaureate and masters degrees. Questions about the accreditation of Voorhees University may be directed in writing to the Southern Association of Colleges and Schools Commission on Colleges at 1866 Southern Lane, Decatur, GA 30033-4097, by calling (404) 679-4500, or by using information available on SACSCOC’s website (www.sacscoc.org).

SSSP Application