Fall Traditional Application

Section 1: Applicant Information
Page 1 of 1
Personal Information
You must provide a valid email address in order to receive important communications from SSCC about your admission status. If you do not have an email address, you can get one at www.gmail.com or www.yahoo.com .
1. 
Email Address (REQUIRED)                          
*Required, Format: x@x.xx
2. 

First Name (as it appears on your Social Security card)

*Required, Maximum characters allowed: 30
3. 
Middle Initial
Maximum characters allowed: 30
4. 

Last Name (as it appears on your Social Security card)

*Required, Maximum characters allowed: 60
5. 

Suffix (if applicable)

6. 
Preferred Name
Maximum characters allowed: 30
7. 
What is your birth name?
Maximum characters allowed: 30
8. 
Date of Birth
*Required, Format: mm/dd/yyyy
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9. 
What is your mobile/cell phone number?
Format: 123-456-7890
10. 

What is your Home Phone Number ((if different than mobile/cell)?

Format: 123-456-7890
11. 

By providing my phone number(s) I understand I will receive important College related text messages and TTS (text to speech) messages from Southern State.

*Required
12. 
Gender
13. 
Social Security Number
*Required, Format: 123-45-6789
14. 
Citizenship Status
*Required
15. 

Citizenship

*Required
16. 
Ethnicity
17. 

Race (select one or more of the following races:)

18. 
Are you a veteran/service member? If β€˜yes’ a copy of your military/service ID must be submitted to the Records Office.
*Required
Mailing Address Information
19. 
Street Address                                                                   
*Required, Maximum characters allowed: 60
20. 
  P.O. Box (if applicable)           
Maximum characters allowed: 60
21. 
City                  
*Required, Maximum characters allowed: 25
22. 
State 
*Required
23. 
Zip Code  
*Required, Format: 12345 OR 12345-6789 OR 123456789 OR A1B 2C3
24. 
County
*Required
25. 
Have you lived in Ohio for the past 12 months?
*Required
26. 
If no, previous state of residence
27. 
Date moved to Ohio
Format: mm/dd/yyyy
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Anticipated Enrollment Information
Note: You must be degree-seeking to be eligible for financial aid.
28. 

Division of Interest

*Required
29. 
Enrollment Status
*Required
30. 

Enrollment Classification

*Required
31. 

Anticipated Enrollment Term 

*Required
32. 

Anticipated Enrollment Year Begin Date

*Required
33. 

Which campus would you like to attend?

*Required
34. 
Program of Interest
*Required
35. 
My Educational Goal is
*Required
High School / GED Information
36. 
High School / GED (name of high school or enter "GED" if applicable)
*Required, Maximum characters allowed: 120
37. 
High School City / State
*Required
38. 
Date of Graduation / GED Received
*Required, Format: mm/dd/yyyy
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Other College Information
39. 
Last College/University Attended
Maximum characters allowed: 120
40. 
Last Attended College/University City
Maximum characters allowed: 25
41. 
Last Attended College/University State
Parent Information
42. 
Father's Highest Level of Education
43. 
Mother's Highest Level of Education
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