TRiO Application Mobile

TRiO Eligibility Criteria

If you are/will be a student at Centralia College
Be a U.S citizen or permanent resident
Be a first generation college student (neither of your parents have a four year college degree), meet federal low-income eligibility requirements (usually if you qualify for a Pell grant), or have a documented disability.
Plan to register for at least 10 credits per term.
Plan to graduate Centralia College.
Do not currently have an Assoicate degree or higher.

Instructions

Please fill out all answers including the two essay questions before submitting your application.

It is not possible to save your application before submitting, so please be sure you have the information to answer each question before you begin.

You may want to work on the essay questions on a word processor and then cut and paste them into the appropriate box on the application.

You will be asked to sign the application. Sign with your finger if your device allows. Otherwise, sign with your mouse/mouse pad.Edge and Firefox browsers seem to work the best for touch-screen finger signing.

We look forward to receiving your application! Feel free to call our office at (360) 623-8770 if you need assistance or if you need alternative format.

General

Have you earned an Associate's (2 year) degree or higher?

Yes

No

Please, make a choice.

If you have already earned a 2-year degree (Associate's degree) or higher, you are not eligible for Student Support Services at Centralia College.

First Name

Please let us know your name.

M.I.

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Last Name

Please let us know your name.

StudentID

(000000000 if unknown)

Invalid format! Your School ID (Must have 9 numbers (eg., 111111111).

Date of Birth

Date format: "mm/dd/yyyy"

Review the date format
Example:09/22/1960

Gender

Male

Female

Please, make a choice.

Ethnicity (Check all that apply to you)

Address

Please, provide your street address.

City

Please, provide your city of residence.

State

Please, provide your state of residence.

Zip

Please, provide your zip code.

Home Phone

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Cell

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Ok to text cell phone?

Yes

No

Invalid Input

Email

Centralia email preferred.

Please, provide your Centralia College E-mail.

Other Email

Please let us know your email address.

The best way to contact me:

Please, make a choice.

Goals

Please answer all questions on each part of this application before selecting the "Submit" button.
Are you registered for 10 or more college level credits [100 level or above]?	Yes No Please, make a choice.
Do you plan to graduate from Centralia College?	Yes No Please, make a choice.
Which program or degree are you planning to complete at Centralia?	Please, provide an intended program of study.
Which major are you planning to complete at Centralia? If undecided, Type "Undecided"	Please, provide an intended major of study.
Do plan to transfer for a bachelor's degree?	Yes No Undecided Please, make a choice.
If you plan to transfer, which college do you plan to attend?	Invalid Input
What is your intended career? If undecided, Type "Undecided"	Please, provide an intended career.

Essays

Please answer all questions on each part of this application before selecting the "Submit" button.
1. Can you think of anything that would keep you from completing your degree? (Your answer must be at least 6 sentences)
The essays are required.
2. Why are you interested in joining TRiO Student Support Services? (Your answer must be at least 6 sentences)
The essays are required.

How did you hear about TRiO Student Support Services?

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I certify that to the best of my knowledge, statements I have made on this form are complete and true. Failure to disclose and submit complete and accurate information may result in the denial of acceptance to the Centralia College Student Support Services program. I also understand participation in Student Support Services requires program access to my student records both at Centralia College and intended transfer institutions. I approve release of my grades, transcripts, financial aid information, test results, and any other information related to my educational endeavors to CC Student Support Services, from entities including, but not limited to, Financial Aid, Admissions/Registrar’s Office, National Student Clearinghouse, etc., with the assurance that the information will be held in the strictest of confidence and in accordance with FERPA.

Yes

No

Acceptance Required to Submit

I authorize the Centralia College Student Support Services to use any interviews, pictures, or videos of me in program approved publications such as brochures, radio, TV, print media, recognition awards, newsletters or other promotional materials and/or documents.

Yes

No

Acceptance Required to Submit

Please answer all questions on each part of this application before selecting the "Submit" button.
Has either of your parents completed a 4-year degree (Bachelor's degree)?	Yes No Please, make a choice.
Were you ever been in Foster Care?	Yes No Please, make a choice.
Do you have a documented disability?	Yes No Please, make a choice.
If you have a documented disability have you submitted documentation to the Disability Services Office?	Yes No N/A Please, make a choice.
Are you a United States citizen?	Yes No Please, make a choice.
If not a United States citizen, are you a permanent resident?	Yes No Please, make a choice.
Resident Alien Number (if not applicable, leave blank)	Invalid Input

Please answer all questions on each part of this application before selecting the "Submit" button.
Have you completed the FAFSA?	Yes No Please make a choice.
Are/ Will you be at least 24 years old on Dec 31st of the school year for which you applied for Financial Aid?	Yes No Please, make a choice.
Are you currently or have you been married?	Yes No Please, make a choice.
Are or were you an orphan or were you a ward of the court until age 18?	Yes No Please, make a choice.
Do children live with you and receive more than 1/2 of their support from you?	Yes No Please, make a choice.
Do you provide more than 1/2 the support for other dependents living with you?	Yes No Please, make a choice.
Are you a veteran of the US Armed Forces?	Yes No Please, make a choice.
How many people live in your household?	Please, make a choice.

Number in Family	Taxable Income
1	$17,820
2	$24,030
3	$30,240
4	$36,450
5	$42,660
6	$48,870
7	$55,095
8	$61,335
9	$67,575
10	$73,815

TR
i
O Application

TRiO Eligibility Criteria

Instructions

General

Eligibility

Goals

Background

Financial

Essays

Please answer all questions on each part of this application before selecting the "Submit" button.
Did you earn a high school diploma?	Yes No Please, make a choice.
Did you earn a GED?	Yes No Please, make a choice.
Are you in Running Start?	Yes No Please, make a choice.
Have you attended any other colleges or universities?	Yes No Please, make a choice.
Please provide the name of any other college you have attended? (if not aplicable, use "None")	Invalid Input
Have you ever been on academic warning in college?	Yes No Please, make a choice.
Have you ever been on financial aid warning?	Yes No Please, make a choice.
Will you be receiving financial aid for school this coming year?	Yes No Please, make a choice.
Is English your second language?	Yes No Please, make a choice.
How long have you been out of school?	Invalid Input
Do you need advice for transfer planning?	Yes No Please, make a choice.
Have you participated in TRiO, CAMP, Talent Search, Upward Bound, or GEAR UP before?	Yes No Please, make a choice.
If you have you participated in TRiO, CAMP, Talent Search, Upward Bound, or GEAR UP before, which program and school? (if not applicable, leave blank)	Invalid Input

Was your family's taxable income for last year Less or More than the amount shown on the chart above for the number of people in household?	Please, make a choice.
Taxable income is not the same as gross or adjusted gross income. Look at the following lines on your taxes for last year: Form 1040 -line 43, Form 1040A - Line 27, Form 1040EZ - Line 6.