Submit Your Application

Thank you for your interest in our Puerta de Oportunidades program at Clatsop Community College! Please complete this application as thoroughly as possible.

You cannot save and restart this application. You may want to review the included items. Take some time to make notes, gather the required documents, and then return to submit your application. If you need to edit the application after it has been submitted or have any questions, please contact our office at 503-338-2346.

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General Information

First Name *

Preferred First Name

Last Name *

Date of Birth *

Mailing Address *

City *

State *

Zip Code *

Phone Number *

Cell Phone Number

Student Email *

CCC ID

Preferred Pronouns (ex she/her/hers; he/him/his; they/them/theirs)

Gender Identity *

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Are you currently admitted or enrolled at CCC? *

Have you attended CCC before? *

Do you have a documented disability? *

Do you receive accommodations at CCC for a disability? *

Did a parent or guardian earn a Bachelor degree from a university? *

Are you an Oregon Promise recipient? *

Are you eligible for federal financial aid? *

Were you a participant of any of the following programs?

Upward Bound

Talent Search

Juntos

Where was the program you participated in located?

What is the highest level of school you have completed or the highest degree you have received? *

Have you attended another college? *

Please tell us the name of the college you previously attended

Ethnicity: Do you consider yourself to be Hispanic or Latino? (A person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.) *

Race (Please check all that apply to you):

American Indian or Alaskan Native - A person having origins in any of the original peoples of North or South America (including Central America), and who maintains tribal affiliation or community attachment. *

Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, and the Indian subcontinent. This area includes, for example, China, India, Japan, Korea, and the Philippine Islands. *

Black or African American - A person having origins in any of the black racial groups of Africa. *

White - A person having origins in any of the original peoples of Europe, North Africa, or the Middle East. *

Hawaiian or other Native to Pacific Island - A person having origins in any of the original peoples of Hawaii or Pacific Islands such as Samoa and Guam. *

Please select one:

I am a DACA or Dreamer Student at CCC

I am a US Citizen

I am a Permanent Resident

I do not identify with any of the above

What is the degree you are working towards? *

Please describe your educational and career goals *

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Please confirm that you have read the following statement and certify the accuracy of the information provided.

I certify, that to the best of my knowledge, the information I provided on this application is true and correct. I authorize personnel associated with the Puerta de Oportunidades Program to obtain, copy and/or review my records, including, but not limited to, high school and college transcripts, test scores, financial aid records, final grades and enrollment status at any college or university, so that Puerta de Oportunidades Program can determine eligibility for the program. I also authorize Puerta de Oportunidades staff to discuss my academic and personal needs with other CCC staff. I understand all prospective students must meet specific federal eligibility requirements to be considered for the program.