Enrollment Event - Springfield

Express Enrollments

Contact Information

First Name

Preferred Name (if different from First Name)

Last Name

Choose ID

Student ID

Date of Birth

Clark State Email

Personal Email

Phone Number

May we text you?

How did you hear about this event?

Admissions Specialist

Mailing

Text

Social Media

Friend/Family

Please check tasks you would like to complete during your appointment.

Make Your Checklist

Complete FAFSA (Financial Aid Process)

Explore Military Benefits

Meet with Career Services

Pay Your Balance

Take Placement Assessment

Take a Campus Tour

Would you like to answer optional questions to help determine any additional needs you may have?

Determining eligibility for additional scholarships and funding.
Connecting with offices responsible for supporting specific needs.
Exploring need and eligibility for assistance with economic hardships.
Discovering ways to engage and connect with other students at Clark State.

Answer Questions?

Student Questionnaire

Your responses will trigger an email customized with information about the office(s) available to support you.

Academic Information

The following questions relate to your role as a student. Your responses will help us connect you with key resources and develop programs related to the interests of you and your peers. These questions are not required, but help Clark State create opportunities for engagement and belonging.

Payment
What will be your primary method of paying for classes and materials? Select all that apply.

Employee Benefits

Financial Aid (scholarships and grants)

Financial Aid (loans)

Self-Pay (divided payments)

Self-Pay (pay-in-full)

Self-Pay (family contributions)

Veteran Benefits

Unsure

Technology Needs
Which of the following, if any, do you feel you will need help with?

adding and using Microsoft Office to your computer

help using computers and the internet for the first time

submitting assignments and navigating Blackboard

using Clark State's email (Outlook)

Do you have reliable access to a laptop or computer?

Accommodations
Office of Accessibility Services helps students with disabilities (mental health, physical, learning, pregnancy, etc.) establish reasonable accommodations for their classes/ program. Those who had an IEP or 504 plan in high school often qualify along with those with varying degrees of anxiety and depression. Would you like information about possible accommodations offered by Clark State for students with diagnosed medical conditions and disabilities?

Interest Inventory
Select all of the following that are interesting to you and are hoping to participate in.

addiction and recovery

anime and manga

art, music, and theater

childcare and parenting

computers and coding

diversity, identity, and advocacy

fitness, health, and wellbeing

reading or writing clubs

sports and outdoor activities

student support groups

video and table top games

volunteering

Economic Background

The following questions collect information regarding the services you may be eligible for based on your family background, basic human needs, and economic status. Your responses will recommend services and resources that can help you in these areas. These questions are not required, but help Clark State ensure you receive every benefit you are eligible for.

Family History

Students may be eligible for additional funding and opportunities based on the environments and families in which you were raised.

Were you ever part of the Foster Youth System?

What is the highest level of education completed by any of your parents or guardians?

Are one or more of your parents or guardians serving, or have served, in active duty with the U.S. Armed Forces?

Can a parent or guardian claim you as a dependent?

Household Information

Most local, state, and federal programs are based on household size and income. Based on your answers, we may be able to help you qualify for programs that help alleviate various economic and medical barriers.

Marital Status
What is your marital status as of today?

Children
Do you now have or will you have children who will receive more than half of their support from you within the next nine months?

Dependents
Do you have dependents (other than your children or spouse) who live with you and who receive more than half of their support from you?

Household Size
How many people are in your household?

Household Income
What is the total adjusted gross income of all members in your household? Adjusted gross income is the amount you receive in cash when all taxes and deductions are applied.

Housing Status
Are you or have you been without a regular and adequate nighttime residence or unable to secure independent housing in the last three months?

Employment Status

Some individuals may be eligible for additional support based on their employment status. Also, Clark State can help create degree plans that best fit with a student's weekly work hours.

Did you or anyone in your home leave a job or lose a job within the last 60 days?

Currently employed?

Hours per Week:

Do you have reliable and sufficient transportation?

Supplemental Resources

Indicate if you would like additional information about the following programs and resources.

Federal Benefit Status
At any time during in the past year, did you, your spouse, or anyone in your household receive benefits from any of the federal programs listed?

Medicaid or Supplemental Security Income (SSI)

Supplemental Nutrition Assistance Program (SNAP)

Free or Reduced Price Lunch

Temporary Assistance for Needy Families (TANF)

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Resources
Would you like additional information on any of the following resources based on your current needs?

childcare

computer

counseling

food

heating and air

housing

internet

medical coverage

phone

pregnancy

textbooks

transportation