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TRIO SSS Application

TRIO Student Support Services is a federal program that provides assistance with advising, transfer planning, career & major planning, financial literacy and tutoring in math & science.

If accepted to the program, you will work with an TRIO SSS advisor for advising and transfer planning on a quarterly basis.

Before completing this application, please make sure you have reviewed our program criteria at www.columbiabasin.edu/sss.
General Information
CBC Student ID *
First Name: *
Middle Name
Last Name: *
Date of Birth (xx/xx/xxxx) *
Address: *
City: *
State: *
Zip: *
Cell Phone Number: *
CBC Email (@students.columbiabasin.edu): *
Academic Information
1. Have you earned a High School Diploma or GED? (Running Start students are not eligible for the SSS TRIO program.) *
2. What is your current program at Columbia Basin College *
TRIO SSS serves students working on their first AA/DTA degree who plan to transfer. Students in certificate or Bachelors programs, or those with a prior AA degree, are not eligible.
3. What is your intended Major at a 4-year institution? *
If "Other," please elaborate:
4. Where do you plan to transfer? *
If "Other," please elaborate:
5. What is your Career Goal? *
6. What is your enrollment status?

Which TRIO services are you interested in?:
Personalized Academic Advising
Personalized Transfer Planning
Personalized Educational Counseling
Financial Aid Information/Literacy
Personalized Major/Career Planning
One-on-One Tutoring in Math & Science
Campus Visits
Educational Access
Is there another way not listed that we can support you?
Academic Need Assessment:
Please choose the option that best reflects your Academic Need. *
Please elaborate on why chose the above Academic Need. *

Personal Information

Program Eligibility:
7. Has your parent(s) or guardian(s) earned a Bachelor's Degree? *
If yes, did you regularly reside and receive support from them?
8. Do you have a disability? *
If Yes, Is your disability currently documented with CBC's Disability Support Services (DSS)?
9. Please select your citizenship status (Eligibility requirements set by the Department of Education: must be a U.S. citizen or permanent resident): *
10. Why do you want to join SSS/TRIO? *
11. How did you hear about TRIO SSS? *
Please provide the name of your referrer (Optional):

Demographic Information:
Gender *
Ethnicity - Are you Hispanic/Latino? *

What is your Race? - Select YES for all that apply (MUST SELECT YES FOR AT LEAST ONE OPTION):
American Indian or Alaskan Native *
Asian *
Black or African American *
Hawaiian or other Native to Pacific Island *
White *

Income Verification Step 1

TRIO Student Support Services is a federal grant through the US Department of Education.The following questions will help us determine if you meet federal low income guidelines. 
12. Are you married or separated but not divorced? *
13. Do you have any dependants who receive more than half of their support from you? *
14. At any point since you turned 13, were you in foster care? *
15. Are you a US Armed Forces Veteran or currently serving on active duty? *
16. Do you have independent status with financial aid? *

Income Verification Step 2

If you are less than 24 years old and you answered NO to all questions in Step 1, please use your household taxable income (Line 15 - Tax Form 1040) to answer the following questions. 

If you are at least 24 years old or you answered YES to any question in Step 1, please use only your taxable income (Line 15 - Tax Form 1040).
17. Are you 24 years old or older? *
18. What is the total number of persons in household (including yourself) *
19. What was your household's taxable income (Line 15 - Tax Form 1040) on your most recent tax return? *

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. 

I understand that the information that I provide to TRIO SSS will be kept confidential and follow the rules and policies of Columbia Basin College. I authorize TRIO SSS to obtain, copy, and/or review my educational and financial records as needed. I understand that failure to disclose accurate information may be grounds for dismissal from the program.

Applicant Sign and Submit:

If you are less than 24 years old and you answered NO to all questions in Step 1, both you and a parent or a guardian must sign below.

If you are at least 24 years old or you answered YES to any question in Step 1, only your signature is required.
Applicant Signature *
Signature Type: Simple    Start Over
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Signature: (Type in your full name)
I agree to the terms included.
Parent/Guardian Signature
Please select a signature verification type.