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					                WELCOME TO STUDENT SUPPORT SERVICES
New opportunities are now available for you, and we hope that you will become an active
Student Support Services Participant. We offer a variety of services and we would love to see
you involved. Please come by to see us so that SSS staff can assist your educational endeavors
while a student at GSW state University.

The following activities are open to all SSS Participants free of charge:

Career Exploration

*Assistance in deciding on a major/career field
*Information regarding career opportunities
*Job Search Skills such as resume writing and interview techniques

Workshops

*Test-taking skills                           *Note taking
*Stress Management                            *Time Management
*Career Decision Making                       *Resume Writing
*Test Anxiety                                 *Essay Writing
*Regents’ Exam Preparation                    *Financial Aid
*Graduate School Selection                    *Improving Memory

Cultural Activities

*Concerts                                     *Speakers
*Plays                                        *Art Shows
*Tours                                        *Convocations

Graduate School Enrollment

*Visits to Graduate Schools
*Assistance with Applications
*Information on studying for the GRE, LSAT, and MAT

Tutoring

*Individualized Tutoring in almost every course especially English, Mathematics, and Science

Disability Services-*Accommodations are provided for students with a documented disability.
                                      Georgia Southwestern State University
                           STUDENT SUPPORT SERVICES APPLICATION
All information disclosed on this form will be held in confidence. Please complete the application in its
entirety. If a question does not apply to you, please note N/A (Not Applicable). This application should be
returned to the Student Support Services department in the Sanford Hall Building, Third Floor. If you have
any questions, please contact us at (229) 931-2294. Thank you.

Name ________________________________________________________________________
     Last                       First                     Middle Initial

Social Security #: ________________________            GSW ID #: _________________________

Gender (   ) Female    (     ) Male     Age _______________           Ethnicity          __________________

Date of Birth ______________________

Classification (   ) Freshmen (       ) Sophomore ( ) Junior      (       ) Senior   (   ) Graduate

Are you a U. S. Citizen? (     ) Yes (     ) No   If no, what nationality? ____________________

Transfer Student (    ) Yes (     ) No    If yes, from what college? _________________________

Home Address ________________________________________________________________
             Street                              City      State      Zip

Phone # ________________________________ Alternate # _____________________________

Local/GSW box _____________

Family Information:

Did either of your parents earn a bachelor’s degree: (    ) Yes       (      ) No

Yearly income, after taxes ________________________ (Family income if living with family;
personal income if considered by financial aid guidelines as an independent student)

Number of persons dependent on family income ______________________________________

Have you been awarded financial aid for the semester in progress: ( ) Yes (              ) No

Do you have a documented disability for which you are requesting services? ( ) Yes (             ) No



I agree that all the information provided above is true. I understand that if I enroll in the Student Support Services
Program, I must participate in activities designed to achieve my academic goals and promote cultural growth.

Signature _________________________________ Date _______________________________
                     STUDENT SUPPORT SERVICES
                      RELEASE OF INFORMATION

I grant permission for the Financial Aid Office to release a copy or copies of Financial Aid information
to the Student Support Services Program. I understand that this form is necessary to establish eligibility
for participation in the Student Support Services Program.

Name___________________________________________________________________



GSW ID # _______________________________             Date _________________________



Student’s Signature _______________________________________________________
                       STUDENT SUPPORT SERVICES
                        RELEASE OF INFORMATION

I grant permission for the Registrar’s Office to release a copy or copies of my academic records to the
Student Support Services Program. I understand that this form is necessary to establish eligibility for
participation in the Student Support Services Program.

Name___________________________________________________________________



GSW ID # _______________________________             Date _________________________



Student’s Signature _______________________________________________________
                                                                                  Student Support Services
                                                                                         229.931.2294 OFFICE
                                                                                         229.931.2832    FAX



                                                           800 Georgia Southwestern State University Drive
                                                                            Americus, Georgia 31709-4379


I understand that Student Support Services’ goal is to enhance my time here at Georgia Southwestern
State University through tutoring, counseling, workshops, and cultural trips. Therefore, by signing
this form, I am agreeing to:

   *   Attend class as set forth by the institution.

   *   Meet with my counselor/coordinator at least twice each semester (3rd Floor Sanford Hall).

   *   Attend at least two cultural activities with or without the Student Support Services program. I will
       report any cultural trips I attend not sponsored by Student Support Services.

   *   Attend at least two academic workshops each semester sponsored by the institution or Student
       Support Services.

   *   Participate in individual and group testing if requested to determine cultural, vocation,
       educational, and personal needs.

If I am suspended from the college for poor academic performance, I understand that the Program
Director may recommend to the Vice President of Academic Affairs that I be readmitted for the next
semester. Recommendation for readmission to the university is contingent upon my participation in
the program.

I understand that I will be notified of any changes made to this contract.

I understand that either the Program Director of Student Support Services or I may void this
contract without any obligations. Nevertheless, I am aware that federal regulations require
Student Support Services to track me until I graduate.

_______________________________________                  ___________________________
        (Student’s Signature)                                  (Date)


_______________________________________                  ___________________________
        (E-mail Address)                                       (Date)


_______________________________________                  ___________________________
        (Staff’s Signature)                                    (Date)
                        STUDENT SUPPORT SERVICES PROGRAM
                           STUDY SKILLS NEED ASSESSMENT


Please mark the following statements according to how much you believe you need help with the
particular study skill area.

1.     I need help scheduling time for studying.
       Never ____         Almost Never _____            Sometimes _____     Often ______

2.     I need to learn how to stick to my schedule.
       Never ____         Almost Never _____        Sometimes _____         Often ______


3.     I need to learn how to use my time effectively.
       Never ____         Almost Never _____         Sometimes _____        Often ______

4.     I need to learn how to take better notes in class.
       Never ____         Almost Never _____           Sometimes _____      Often ______

5.     I need to learn how to get more out of reading material.
       Never ____         Almost Never _____         Sometimes _____        Often ______

6.     I need to learn how to concentrate better while studying.
       Never ____         Almost Never _____          Sometimes _____       Often ______

7.     I need to learn how to identify and focus on important material.
       Never ____         Almost Never _____          Sometimes _____       Often ______

8.     I need help taking objective examinations.
       Never ____          Almost Never _____           Sometimes _____     Often ______

9.     I need help taking essay examinations.
       Never ____          Almost Never _____           Sometimes _____     Often ______

10.    I would attend a Study Skills Workshop.      (     ) Yes    (      ) No

Please indicate additional study skill components you would like to see included in a workshop
Name ____________________________________                  Date _____________________
                            Academic Progress
A grade point average of 2.00 (C average is required for graduation from Georgia Southwestern State
University. Some curricula require a higher grade point average. A student whose performance is
below this level exhibits academic deficiencies. The university uses the cumulative/institution grade
point average. This grade point average is used in determining academic standing. The following
table shows the minimal cumulative/institution grade point average a student must achieve to make
acceptable progress toward the 2.00 average and graduation. Transfer students; please pay close
attention to hours transferred in from another institution as it relates to required minimum
GPA.

Total Hours earned including                                Required Minimum
Hours accepted in                                           Cumulative/Institution
Transfer                                                    Grade Point Average

 0-15                                                       1.50
16-30                                                       1.65
31-60                                                       1.75
61 and above                                                2.00

The grade point average is calculated each term and appears on the grade report to inform the student
of one’s progress. The academic status of the student will be printed on the grade report. The
categories used by the University are Good Standing, Academic Warning, Academic Probation,
Academic Suspension, Restricted Enrollment, and Developmental Studies.


Student’s Name __________________________________________


Student’s Signature _______________________________________


GSW Student ID # ________________________________________
                      STUDENT SUPPORT SERVICES
                           RELEASE OF INFORMATION


Disability Verification

I grant permission for _____________________________________________________________
to release information concerning my disability. I understand that this information is necessary to
verify my disability and to obtain academic accommodations.

I understand that documentation must be on professional letterhead and signed by a licensed
professional or it is not sufficient.

I understand that documentation must include:

       >       A definitive diagnosis
       >       Address the length and severity of impairment, how it currently manifest in
               substantial limitations in academics
       >       Suggestions for appropriate accommodations
       >       Any medications being taken and their side effects

Please return requested information to:

Georgia Southwestern State University
Student Support Services/Disability Services
800 Georgia Southwestern State University Drive
Americus, Georgia 31709-4379

Name ________________________________________________

Social Security # _____________________ Date ________

Student’s Signature __________________________________
       Testing Procedures with Student Support Services

If professor decides students are to be tested here (Testing Room), students will not be allowed to
take items below in Testing Room unless Professor specifies:

   1) Take book bags into room

   2) Take purses into room

   3) Take paper or notes

   4) Use cell phones

   5) Use computer

   6) Take their completed tests back to their professor

   7) Calculators

   8) Tape recorders

   *All tests are to be hand delivered to the Disability Coordinator or
    emailed to eoliver@gsw.edu

   *Pens and pencils will be provided if student requests them

   If there are any questions please feel free to contact me at 931-2661.



                                             Student Signature



   Evelyn Oliver- Disability Coordinator