Submit Your Application

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 TRIO SSS staff 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

What is your intended Major at a 4-year institution? *

What is your current program at Columbia Basin College *

TRIO SSS serves students working on their first AA/DTA/AS-T/AAS degree who plan to transfer to a 4-year program. Students in certificate or Bachelors programs, or those with a prior AA degree, are not eligible.

If "Other," please elaborate:

Where do you plan to transfer? *

If "Other," please elaborate:

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:

Has your parent(s) or guardian(s) earned a Bachelor's Degree? *

If yes, did you regularly reside and receive support from them?

Do you have a disability? *

If Yes, Is your disability currently documented with CBC's Disability Support Services (DSS)?

I am a U.S. Citizen or Permanent Resident. *

Why do you want to join SSS/TRIO? *

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

TRIO Student Support Services is a federal grant through the US Department of Education. We use federal low-income guidelines to determine income eligibility. Please answer the following questions to the best of your ability.

If you are less than 24 years old or have dependent status with Financial Aid, 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 have independent status with Financial Aid, please use only your taxable income (Line 15 - Tax Form 1040).

What is the total number of persons in household (including yourself) *

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:

Applicant Signature *

Signature Type: Simple Start Over

Reset Signature Pad

Click here to start signing.

Pencil
Reset

Signature: (Type in your full name)

I agree to the terms included.