• Mt. Hood Community College

    TRIO Student Support Services

    Program Application

  • Instructions & Notes

    1. Please answer all of the questions, including the short answer questions, before submitting your application to TRIO Student Support Services (SSS).
    2. This application, academic transcripts, placement test scores (if applicable), and a personal interview are used to determine your eligibility to participate in the TRIO-SSS program.
    3. Qualifying for participation in the TRIO-SSS program is competitive.
    4. I need a quick reminder regarding basic eligibility criteria for TRIO-SSS
    • Biographical Information 

    • (Please fill in all of the information)

    • Date of Birth*
       - -
      2 digit month, 2 digit day, 4 digit year
    • Can we text this number?*
    • Gender Identification Matching State ID*

    • Ethnicity

    • Do you consider yourself to be Hispanic or Latino/a/x?*
    • Race (Please Check All Boxes That Apply to You)*
    • Eligibility Questions 
    • Do you have a parent or guardian who has completed a 4-year degree (Bachelor's degree)?*
    • Do you have a documented disability?*
    • Are you currently working with Accessible Education Services at Mt. Hood Community College for accommodations related to your disability?*
    • I give permission for Accessible Education Services at Mt. Hood Community College (MHCC) to share information, as needed, regarding my condition and/or accommodations with TRIO Student Support Services at MHCC.*
    • Are you a citizen or national of the United States or meet the residency requirements for Federal student financial aid (FAFSA)?*
    • Do your educational goals include earning an Associate’s degree or Certificate at MHCC?*
    • Do you plan on transferring to a 4-year school to pursue a Bachelor’s degree after graduating from MHCC?*
    • Educational Background Questions 
    • Did you graduate from high school?*
    • Did you earn a GED?*
    • Have you previously attended other colleges or universities?*
    • If “Yes”, did you earn college credits there?*
    • Are you attending MHCC at least ¾ time (9 credits or more, excluding summer term)?*
    • Financial Questions Part 1 
    • Are you married?*
    • Do you have children or other dependents (other than spouse) who receive more than half their support from you?*
    • Are you serving on active duty (other than for training purposes) in the United States Armed Forces? *
    • Are you a veteran of the U.S. Armed Forces who was on active duty and was discharged under a condition other than “dishonorable?”*
    • Are you currently or have you ever been in the foster care system?*
    • Have you been determined as a homeless youth (i.e. you lack a fixed, regular, and consistent nighttime residence) by an educational agency, such as a school district?*
    • Financial Questions Part 2 

    • You must answer the following question about yourself if you are at least 24 years old or you answered YES to any question in Part 1.

      Your parent(s) or guardian(s) must answer the following question about themselves if you are less than 24 years old and you answered NO to all questions in Part 1.

    • Did you report your parent/legal guardian’s income on your most recent FAFSA application?*

    • If you report your parent/legal guardian’s income on the FAFSA, you must use your parent/guardian’s income for this section, and they must sign at the end of this application.

    • If you do not report you parent/legal guardian’s income on the FAFSA, you must use your own income for this section.

    • You must report your individual income if you are at least 24 years old or you answered YES to any question in Financial Questions Part 1.

      Your parent(s) or guardian(s) must report their income if you are less than 24 years old and you answered NO to all questions in Financial Questions Part 1.

    • Please select below the type of benefits that you and/or your household received in 2021. Please select any and all that apply.*
    • What was your family’s income from last year?*

    • If you report your parent/guardian’s income on the FAFSA, you must use your parent/guardian’s income for this section, and they must sign at the end of this application.

    • What type of income and/or benefits did you and/or your family receive this past calendar year? (You may select all that apply)*
    • Assessment Questions 
    • Are you a former TRIO Student? (Upward Bound, Talent Search, Student Support Services, Educational Opportunity Center)*
    • Do we have your permission to inform your former TRIO program that you are working with us?*
    • What TRIO program were or are you in?*
    • Please check each of the boxes that apply to you
    • Do you have reliable access to a computer/laptop for your schoolwork?*
    • Do you have reliable internet access?*
    • Do you have reliable transportation?*
    • Do you/your household have regular access to appropriate amounts of food?*
    • If you have children, do you have access to regular/reliable childcare?*
    • Do you receive federal financial aid, scholarships or grants to pay for college?*
    • Are you currently working while in school?*
    • Do you know how to access your financial aid status and award on MyMHCC?*
    • Are you interested in applying for scholarships?*
    • Are you interested in learning how to create a budget and manage your money?*
    • Do you need to work on time management/organization?*
    • Are you interested in getting academic tutoring and study skills support?*
    • Please check all of the services TRIO-SSS provides that interest you (Please check all that apply)*
    • How did you hear about the TRIO-SSS Program?*
    • Short Answer Questions 

    • Qualifying for Participation in the TRIO-SSS program is Competitive. Please type your responses in the space provided next to the questions. We suggest typing around 100-200 words for each question.

    • Terms & Conditions Agreements 

    • MHCC TRIO-SSS Photo Release Agreement

    • By selecting Yes below, you are giving consent for the Mt. Hood Community College TRIO Student Support Services Program to take photos and video footage of you, in the event that TRIO hosts activities, events, and off-campus trips, for student engagement and recruitment purposes via program advertising and marketing, that may be published and disbursed via printed media, digital media and social media.*

    • Description of video/photographs

      This Photo Release Agreement applies to any and all videos/photographs of the student, or video/photographs in which the student is included, made/taken by the Mt. Hood Community College TRIO Student Support Services program for activities, events, and to all reproductions in any medium of such videos/photographs.

      Use of the videos/photographs

      The student consents to, and authorizes the use of the videos/photographs by the Mt. Hood Community College TRIO Student Support Services program (including authorized representatives and successors), and assigns for any purpose whatsoever, including without limitation:  publication, reproduction in any and all media, exhibition or any other form of promotion and/or publicity.  The student agrees the videos/photographs may be used without compensation for an unlimited time and that this Photo Release Agreement is irrevocable.

      Ownership rights in the videos/photographs

      The student agrees that the videos/photographs, the copyright in the photographs and all other rights in the photographs or copies or reproductions in medium are the sole property of the Mt. Hood Community College TRIO Student Support Services program.

      Release from liability

      The student releases the Mt. Hood Community College TRIO Student Support Services program and all other persons entitled under this Photo Release Agreement from all liability for libel, invasion of privacy, and all causes of action whatsoever in relation to the photographs, their making and use.

      FERPA

      The student understands that photographs or video depicting the student may constitute educational records as defined by the Family Educational Rights and Privacy Act (“FERPA”), and the student hereby consents to the release of those records.

    • Signature(s) 

    • People requiring accommodations due to a disability should contact the Accessible Education Services at 503-491-6923. Please call at least 2 weeks prior to the event.

      Please read the following statement and then sign and date it below. If you (the student) are less than 24 years old and answered NO to all of the questions in Financial Questions Part 1, your parent or legal guardian must also read the following statement and then sign and date below it.

      By signing this application, I attest that all of the information on this application is true and accurate. I understand that the information that I share with TRIO Student Support Services (TRIO-SSS) staff will be kept strictly confidential and adhere to the rules and policies of Mt. Hood Community College. I authorize the TRIO-SSS program to obtain, copy, or review my records, including high school and college transcripts, test scores, financial aid reports, school progress reports, final grades, and other records as needed. Finally, I agree to fulfill the expectations for active participation in the TRIO SSS program. 

    • Date*
       - -
      2 digit month, 2 digit day, 4 digit year
    • Date*
       - -
      2 digit month, 2 digit day, 4 digit year
    • Submit 
    • Should be Empty: