Thank you for your interest in ECU's Student Support Services program!  Please complete this application as thoroughly as possible.  You cannot save and return to this application.  If you have any questions, please call our office at (580) 559-5833.

General Information:
Last Name: *
First Name: *
Middle Name:
Social Security Number: *
Date of Birth: *
Marital Status:
Are you a U.S. Citizen or permanent resident? *
Are you a U.S. Veteran or a spouse/dependent of a U.S. Veteran?
ECU Student ID: *
Local Address: *
Local Address 2:
Local City: *
Local State: *
Local Zip: *
Home Phone:
Cell Phone Number: *
ECU Email Address: *
How did you hear about us?
Describe your primary reason for applying:

Academic Information:
What is your major? *
Did you transfer from another college? *
Select your highest level of education: *
Current Grade Level:
Enrollment Level:
How's your academic standing?

Eligibility Information:
Parents Educational Level: *
Do you have a disability documented through the Office of Testing and Accessibility? *
If you were required to provide parent/legal guardian information on the FAFSA, please include their information for the following:
How many people are in your household at home? *
Family Income Range: *
Household Filing Status: *
Most Recent IRS 1040:

Applicant Signature: *
Please select a signature verification type.

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, and authorize the SSS program to obtain, review, and discuss the following records:

  • Academic grades and transcripts
  • Course registration
  • Academic progress
  • Financial Aid records
  • Standardized test scores
  • Disability documentation


Sign and Submit: