TRIO Application Form

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TRIO Student Support Services Program Application

The Trio-Student Support Services program provides opportunities for academic development, assists students with college requirements, and serves to motivate
students towards the successful completion of their post-secondary education. The program provides an interconnected series of academic support services such as
study skills development, tutoring to mastering course content, individualized advising, career guidance, campus tours, student success workshops, financial
counseling, and more.

Who is eligible for TRIO SSS?

Eligibility for TRIO/Student Support Services is determined by federal regulations.

To qualify, a student must be a U.S. citizen or permanent resident and meet one or more of the following criteria:

Be a first-generation college student (which means that neither parent has completed a bachelor’s degree)
Meet income guidelines (Total family income is below 150% of the poverty guidelines).
Have documented disability status with OCC’s Office of Accessibility Resources (OAR)

Preference is given to students who have an intent to attend a four-year college after they graduate

First Name

Middle Name

Last Name

Address

City

State

Zip

Email Address

Phone Number

Check this box if you give TRIO permission to send texts to your cell

Student ID Number

Date of Birth

Are you under the age of 18?

Yes

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian's Email

Does your mother have a Bachelor's degree?

Yes

Does your father have a Bachelor's degree?

Yes

Are you a U.S. Citizen?

Yes

Do you have a documented disability with OCC's Office of Accessibility Resources?

Yes

Is your total family income BELOW the amount shown on the chart?

Yes

Size of Family

Family Taxable Income

$22,590

$30,660

$38,730

$46,800

$54,870

$62,940

$71,010

$79,080

Gender:

Male

Female

Other

Ethnicity: Are you Hispanic/Latino?

Yes

Race (check all that apply):

American Indian or Alaska Native

Asian

Black or African American

White

Native Hawaiian or Pacific Islander

Enrolled at OCC?

Yes

Are you in your 1st or 2nd year?

What program are you in?

Do you plan to transfer to a university? (4 year institution)

Yes

Not sure

Advisor First Name

Advisor Last Name

High School Name/GED Program

Location of your High School/GED Program:

Have you been involved in any of the following programs?

TRIO Upward Bound

EOP

CSTEP

Check areas where we can support you in completing your degree:

Time Management

Test Taking Preparation

Tutoring

Learning Strategies

Money Management

Stress Management

Financial Literacy

Find employment on/off campus

Housing

Childcare

Career exploration/information

Resume Assistance

Choosing a major

Course selection/scheduling

Understanding degree requirements

Transfer advising & planning

Campus visits to 4-year universities

FAFSA workshop

Scholarship information

Reference/Recommendation Letters

Other (Please specify)

By submitting this form, I hereby certify that this information is correct to the best of my knowledge. With my signature, I am granting all TRIO SSS personnel access to the information contained on this form and in the OCC system (i.e., transcripts/registration information, grades, placement scores, and more) for the purpose of program, recording, tracking, and reporting as required by the U.S. Department of Education. In addition, I allow OCC TRIO personnel to track my educational progress as they relate to the TRIO program using phone, email, or other digital mediums.

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