Thank you for your interest in our Student Support Services program!  Please complete this application as thoroughly as possible.  You cannot save and restart this application.  You may want to review the included items before submitting. We are excited about your interest and will let you know as soon as possible if you qualify for all the opportunities available through our service.

Last Name: *
First Name: *
Middle Name:
Date of Birth: *
Social Security Number *
Address: *
City: *
State: *
Zip Code: *
Home Phone
Cell Phone Number: *
Email Address: *

Gender *
Marital Status
Race, Hispanic *
Race, American Indian or Alaskan Native *
Race, Black or African American *
Race, Hawaiian or other Native to Pacific Island *
Race, White *
Race, Asian *
Did your mother GRADUATE from a FOUR-YEAR college? *
Did your father GRADUATE from a FOUR-YEAR college *
Do you have a documented DISABILITY? *
Are you receiving financial help? *
If you received financial help, is it from a Pell Grant?

College Entry Grade Level
Where did you attend college before Ranger College? (Write "none" if not applicable.) *
How many college credits have you competed? (Received credit for) *
Are you working toward a two-year degree?
Are you working toward a one-year certificate? *
Do you plan to transfer to a four-year university? *
To where will you transfer? (If you don't know, use "undecided")
Have taken the TSI? *
Did you pass Math? *
Did you pass Reading? *
Did you pass Writing? *
Sport or Activity *

 From the list below, choose the services you are interested in receiving: (Type them into the area provided.)

  • Tutoring
  • Counseling
  • Cultural Education Trips
  • Career Assistance
  • Transfer Assistance/Information
  • Academic Advising
  • Study Skills/Time Management
  • Goal Setting
List the services from the choices above:
Terms of Submission:
By submitting this application, you acknowledge that all of the above information is correct and accurate to the best of your understanding.
Applicant Signature *
Please select a signature verification type.