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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 Major? *
If "Other," please elaborate:
3. Where do you plan to transfer? *
If "Other," please elaborate:
4. What is your enrollment status?

Which TRIO services are you interested in?:
Academic Advising
Transfer Planning
Educational Counseling
Financial Aid Information/Literacy
Major/Career Planning
Tutoring in Math & Science
Campus Visits
Educational Access
All of the Above

Personal Information

Program Eligibility:
8. Are you a first generation college student? (The parent(s) that raised you did not obtain a bachelor's degree before you reached adulthood) *
9. Do you have a disability? (Documented with Disability Support Services) *
10. Please select your citizenship status: *
12. Why do you want to join SSS/TRIO? *
13. How did you hear about TRIO SSS? *

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

TRIO Student Support Services is a federal grant through the US Department of Education. When applying to participate, we must verify your income status.

Please review the following income levels to determine if you are considered low-income and then answer yes or no. Checking “No” does not necessarily mean you cannot participate in SSS/TRIO. If you are under the age of 24, you must also have your parent or legal guardian sign this form.

ANNUAL LOW INCOME LEVEL

(Effective January 15, 2025 until further notice)

Family Size

Taxable Income (Line 15 - Tax Form 1040)

1

$23,475

2

$31,725

3

$39,975

4

$48,225

5

$56,475

6

$64,725

7

$72,975

8

$81,225

Add $5,500 for each additional family member

14. According to the chart above, my family's taxable income (Line 15 - Tax Form 1040) is considered low-income. *

If you are under the age of 24, you must also have your parent or legal guardian sign this form.
Parent Signature (for income verification, only needed if student is 24 years old or younger)
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Signature: (Type in your full name)
I agree to the terms included.

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.
Applicant Sign and Submit:
Applicant Signature *
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Signature: (Type in your full name)
I agree to the terms included.