Thank you for your interest in our Student Support Services 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, please contact the TRIO Student Support Services office. 

If you have any questions, please call our office at 503-338-2346 or email or stop by. We are located in Towler 312.

General Information:
First Name *
Preferred First Name
Middle Name
Last Name: *
Date of Birth *
Mailing Address *
City *
State *
Zip *
Home Phone *
Cell Phone Number *
Student Email *
Social Security Number
CCC ID Number
What is you preferred pronoun (e.g. she/her/hers; he/him/his, they/them/theirs)
Please answer the following questions:
Are you currently admitted or enrolled at CCC? *
Did a parent or guardian earn a Bachelor degree from a university? *
Do you have a documented disability? *
Do you receive accommodations at CCC for a disability? *
Are you receiving veterans benefits? *
Are you a student at Job Corps? *
Are you a US Citizen? *
Are you a permanent resident?
Academic Info:
What is the highest level of school you have completed or the highest degree you have received? *
What is the degree you are working toward? *
What are your educational and career goals? *
Income Verification - Step 1:
Please answer the following questions:
Are you married or separated but not divorced? *
Do you have children or other dependents (other than spouse) who receive more than half of their support from you? *
At any time since you turned 13, were both of your parents deceased, were you in foster care, or were you a ward or dependent of the court? *
Are you currently serving on active duty in the U.S. Armed Forces for purposes other than training? *
Are you a U.S. Armed Forces veteran who was on active duty and was released under a condition other than dishonorable? *
Are you an emancipated minor or are you in a legal guardianship as determined by a court? *
Are you an unaccompanied youth who is homeless (i.e. you lack a fixed, regular, and adequate nighttime residence) or self supporting and at risk of being homeless? *
If you are less than 24 years old, do you have independent status with financial aid?
Income Verification - Step 2:

If you are at least 24 years old, use only your income to answer the following questions.

If you are less than 24 years old and you answered NO to all questions in Step 1, use your family's taxable income to answer the following questions.

If you are less than 24 years old and you answered YES to any question in Step 1, use only your taxable income.

Use your previous years taxes to answer the following questions.
What is the total number of persons (including you) in your family?
What was your individual or your family's taxable income (not total) as stated on the prior year income tax return:
Sign and Submit:
I certify, that to the best of my knowledge, the information I provided on this application is true and correct. I authorize the TRIO SSS Program staff 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, to determine eligibility for the program.
Applicant's Signature *
Please select a signature verification type.
Parent Signature (If family income was provided)
Please select a signature verification type.

If you are having difficulty submitting this application: 

1. Print the application and drop off in Towler 312.

2. Contact the TRIO SSS office. You can call 503-338-2346 or email for assistance.


The TRIO SSS Program is a United States Department of Education TRIO Student Support Services (SSS) project and is completely funded with federal monies., currently funded at $348,048 per fiscal year.