Welcome, and thank you for your interest in the Horizons Student Support Services program!

IMPORTANT: Before you begin your application for the 2025-2026 academic year, please be aware of these points:

You cannot save and restart this application. Therefore, you will want to ensure that you have all the materials you will need and complete the application in one sitting.
You will need to have the following document accessible and ready to upload to your application:
- If you are dependent, you will need to have your parent or guardian's 2023 Tax Return. Please upload a signed copy of the tax return.
- If you are an independent, you will use your 2023 Tax Return. Please upload a signed copy of the tax return.
Please ensure that you have completed the entire application and your information is accurate and thorough.
Note: Horizons completes a verification process based on your application. If there are any determined discrepancies, there is a possibility that you will have to complete an additional step by signing a release form (the Financial Aid Disclosure Consent Form) with the Division of Financial Aid to further verify income eligibility. To avoid this additional step and experiencing a delay in your application process, please ensure you include accurate information from your tax documents.
Note: In the event there are discrepancies, Horizons will inform you to complete the process with the Division of Financial Aid at Purdue University in-person upon your arrival to the University.

If you have any questions, please call our office at 765-494-7094 or email us at horizons@purdue.edu.

Today's Date: *

General Demographic Information:

PUID: *

Purdue Email Address: *

Last Name: *

First Name: *

Middle Name: *

Preferred Name (if not your first name): *

Date of Birth: *

Gender assigned at birth: *

Permanent Address: *

Permanent Address 2: *

City: *

State: *

Zip: *

Cell Phone: *

Please check the box if we may text this number

Please indicate your racial/ethnic background below. (Please answer Yes or No to each option)

Race, American Indian or Alaskan Native *

Race, Asian: *

Race, Black or African American: *

Race, Hawaiian or other Native to Pacific Island: *

Race, Hispanic: *

Race, White: *

Citizenship Status: *

Program Eligibility:

First Generation Status:

Highest Education Level of Mother or Legal Guardian #1: *

Highest Education Level of Father or Legal Guardian #2: *

With whom did you most often reside with until your 18th birthday? *

Income Information:

Financial Aid Dependency Status: *

Did you or your parent(s)/guardian(s) complete an Income Tax Return for the 2023 reporting year? *

What is you or your parent(s)/guardian(s) reported household size on your 2023 Tax Return?

What is you or your parent(s)/guardian(s) reported AGI (annual gross income) on your 2023 Tax Return? This information can be found on Line 11 of your Tax Return.

What is you or your parent(s)/guardian(s) reported taxable income on your 2023 Tax Return? This information can be found on Line 15 of your Tax Return.

Please upload a signed copy of the 2023 Tax Return.

Disability Verification:

Do you have a documented physical, psychological, or learning disability? *

Are you registered with the Purdue University Disability Resource Center (DRC)? *

Additional Information:

Are you a foster child or have you aged out of the foster care system? *

Have you ever been homeless? *

Are you a member of the U.S. Armed Forces? *

Are you a member of the U.S. Reserves? *

Personal Education Information:

Please indicate your previous participation in other TRIO programs. (Check all that apply)

Talent Search

Upward Bound

Educational Opportunity Center

Student Support Services

Academic Status:

How many years have you completed at Purdue University? *

What is your current classification according to credit hours earned? *

Are you a transfer student? *

Academic Need Information (Check all that apply to you):

ACT composite score of 26 or below

SAT composite score of 1200 or below

High School GPA Below 3.0

STEAM Major (Science, Technology, Engineering, Agriculture, Math) Pre-Med, or Nursing

College Cumulative GPA between 2.0 - 2.5

Failing grades in one or more courses

Returning adult student (out of the academic pipeline for 5+ years)

Have you completed your ALEKS assessment (the math placement assessment)? *

If you completed the ALEKS assessment, what was your score?

Please respond to the following statements:

I would benefit from having someone who helps me stay on track towards graduation. *

I feel unsure about how to develop a clear academic plan or choose the right major. *

I struggle with time management, organization, or study strategies. *

I would like academic tutoring in one or more of my current or future courses. *

I need help understanding my financial aid package or managing my college expenses. *

I would benefit from learning more about budgeting, credit, or saving money. *

I am interested in pursuing an internship, but I don't know where to start. *

I would like guidance on preparing for graduate or professional school. *

I would benefit from having a mentor (faculty and/or peer) who can help me get adjusted to college. *

I sometimes struggle with motivation or confidence in my academic abilities. *

I need support navigating university systems (e.g., registration, advising, academic policies and procedures). *

I find it difficult to connect with others or feel a sense of belonging on campus. *

I would benefit from access to cultural enrichment or community-building opportunities. *

I am interested in learning how to advocate for myself and use campus resources effectively. *

I am committed to earning my degree from Purdue University, but I know I need additional support to reach my goals. *

Reflecting on your responses above, please share anything about your background, experiences, and major/career-related goals that you believe would help us understand why you are seeking support through Horizons Student Support Services. *

How did you come to hear about Horizons Student Support Services?

Purdue's New Student Tasklist

Academic Advisor

Horizons Scholar

A Campus Professional

Horizons Outreach Email

Discovered Horizons on Your Own

Other *

Program Expectations

If accepted into the Horizons Student Support Services Program, I agree to actively engage with the program and meet the following expectations during my first semester:

Meet with my assigned Horizons staff member once per semester. I understand that I must also complete a Needs Assessment and Scholar Success Plan yearly.

Actively engage in the Peer Mentorship Program

Attend at least one educational event hosted by Horizons

Attend at least one social event hosted by Horizons or Horizons Student Support Club (HSSC)

As a continuing participant of the Horizons Student Support Services Program, I agree to actively engage with the program and meet the following expectations:

Meet with my assigned Horizons staff member once per semester. I understand that I must also complete a Needs Assessment and Scholar Success Plan yearly.

Attend at least one educational event hosted by Horizons

Sign and Submit:

I am aware that the personal information provided by the Horizons Student Support Services program will be protected under the Family Education Rights Privacy Act of 1974. No one will have access to my information unless they work with or for the Horizons program or are specifically authorized to see information. I understand that any incorrect information on this application may affect my eligibility to receive services from the Horizons Student Support Services program. I give my permission to use my likeness for promotional, recruitment and educational purposes.

I attest that the information I have provided on this application is, to the best of my knowledge, complete and correct. Furthermore, I understand that by applying to the Horizons Student Support Services program, I authorize Horizons program staff to use my Purdue University ID number to obtain records or data pertinent to my participation from other sources. I authorize the release of information, as required by the terms of the TRIO SSS grant, to the grant-funding agency of the United States government. The Horizons program staff have my permission to communicate verbally or otherwise with staff, faculty, and/or off-campus professionals on my behalf.

Applicant Signature: *

Please select a signature verification type.