In order to become a TRiO member, fill out the TRiO SSS application below. The form can be completed in a few minutes.

If you are accepted into the TRiO program, you will be required to attend an orientation and will then be eligible to access tutoring and advising services as well as attend cultural experiences, college university visits and workshops.

Step One
Please answer the following questions about yourself
5a. Do you have a home phone?
6a. Do you have a cell phone?
6c. Would you like to receive text messages?
9. Are you a veteran?
10. Is English your first language?
11. Ethnicity (Please check all that apply to you)

12. Gender
13a. Are you a U.S. Citizen?
13b. If not a US Citizen are you a Permanent Resident?
14a. Are you employed?
Step Two
Please answer the following questions about your parents and about yourself
15. Do either of your parents have a 4-year college degree?
18. Do you have a CURRENT and DOCUMENTED Disability?
19a. Financial Statement of need (check one). The taxable income can be found on the federal income tax return IRA Form 1040 see line 43; IRS Form 1040A see line 27; IRS Form 1040 EZ see line 6.

20a. At the current time are you a

20c. Did you earn a GED?
Step Three
Please answer the following questions about your educational plans
22a. Are you planning on receiving a degree or certificate from KCC?
27. Which of the following services do you need?

28. I have completed the following Math classes

29. I have completed the following Writing classes

30. Academic Need (check all that apply) I have a history of

Step Four
Verification and Release of Information
TRiO SSS can only serve a limited number of students, so not all applicants who are eligible can be accepted. Priority is given to full time, degree seeking students who plan on pursuing a bachelor’s degree.

All information I have submitted on this form is true and complete. I understand this information is confidential and will be used for statistical purposes. Further, in order to verify my eligibility and in the event that I am accepted to the TRiO Student Support Services (SSS), I release the following information to the TRiO SSS Program: Transcripts: Admissions and Registration, Mid-term and Final Grades Information, Financial Aid Information, Standardized Test Scores (ACT/SAT/GED/Compass), Disability Documentation, Income Information (Federal 1040 or other appropriate income documentation), Additionally, I agree to complete an Exit Survey in the event of withdrawal, transferring, or graduation from KCC, and I understand that TRiO SSS Administrators will contact my instructors on an as needed basis.

Parent signature is required for: Students under 24 years of age who are single and have no dependents.

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Klamath Falls OR 97603 541.882.3521
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