STUDENT HELP REQUEST FORM

If you are having any problems at SC State, the Student Success and Retention Program (SSRP) can help. Complete the requested information on this STUDENT HELP REQUEST FORM and click on the submit button.

PLEASE HELP ME WITH (Check All That Apply)

	ACADEMICS (advising, classes, professors, scheduling, etc.)
	FINANCES (financial aid, tuition payment, work-study, etc.)
	LIVING CONDITIONS (housing [on-campus or off-campus], roommate(s), meals, etc.)
	MEDICAL / HEALTH
	PERSONAL / SOCIAL
	OTHER

COMMENTS

MY CONTACT INFORMATION

FIRST NAME:
LAST NAME:
SC STATE BANNER IDENTIFICATION NUMBER
PHONE(S):	CELL HOME
SC STATE EMAIL ADDRESS:
ALTERNATE EMAIL ADDRES:

South Carolina State University

South Carolina State University

Student Success and Retention Program

Student Help Request Form

PLEASE HELP ME WITH (Check All That Apply)

MY CONTACT INFORMATION