Application Form

Thank you for your interest in Student Support Services!

You can submit this form online or print it (download PDF here) fill it out and mail it/ bring it to our office:
Student Support Services
119 Sisson Hall
SUNY Potsdam
44 Pierrepont Ave.
Potsdam, NY 13676

You will be contacted by an SSS staff member within a few days of submitting your application and self-assessment.

DON'T FORGET: YOU MUST ALSO COMPLETE AND SUBMIT AN SSS STUDENT NEEDS SURVEY FORM IN ORDER FOR YOUR APPLICATION TO BE PROCESSED!

Name:

Campus Email (_____@potsdam.edu):

ID#:

Barrington/Local Address:

Home Address:

Campus/Local Phone:

Home Phone:

Birth date:

Gender:

Male

Female

Year in School:

Freshman

Sophomore

Junior

Senior

Race:

African American

Asian American

Hispanic American

Native American

Caucasion

Other

Service(s) being requested:

Are you an EOP student:

Are you a CSTEP student:

Are you a U.S. citizen:

Do either of your parents have a 4-year college degree:

Did you apply for financial aid:

If no, why not:

Do you have a documented learning, physical or emotional disability: