The following information is required by the US Department of Education to ensure we are providing services within our guidelines. All information provided is CONFIDENTIAL as specified in the rules and regulations of FERPA & Centralia College.

The student Social Security or A number is required for submission of the TS online application and acceptance into the program. Please submit your number through this secure site or if preferred, complete a paper application and call in the SS or A number to our office at 360-623-8969.

If student’s primary residence and support is from only one parent, answer for that parent's household.

*Refer to line 15 on Form 1040 of your taxes.
** If student’s primary residence and support is from only one parent, answer for that parent's household.

In order for us to serve you with a strong academic, cultural, and collegiate program, we must have a sincere commitment from you. Please carefully review the following:

I understand that during my participation in TRIO TS:

1. My goal will be to complete middle/high school and pursue post-secondary education.
2. I will maintain at least a 2.5 GPA in middle school and in high school.
3. I will attend all meetings arranged by my TRIO TS Specialist.
4. I will participate in school and virtual TRIO TS meetings.
5. I will abide by all rules and regulations of TRIO TS and Centralia College.
6. Lack of participation will be a basis for dismissal from TRIO TS.

In addition to the application data given here, we will need to obtain information from other sources to sufficiently meet the academic needs of our students and the reporting requirements of the U.S. Department of Education. We gather information from middle schools, high schools, colleges, testing institutions, and other agencies on behalf of our students and program. Your signature at the bottom of this form authorizes TRIO TS to:

1. Request access to your middle/high school transcripts, Skyward account, and state test scores from your school and/or the district.
2. Request a copy of your SAT and/or ACT test scores.
3. Use your Social Security or Permanent Resident number to request a copy of your financial aid application, transcripts, college enrollment status, and awards from federal & state funding agencies, post-secondary institutions, and the National Student Clearinghouse.
4. Communicate with representatives from agencies or post secondary institutions on your behalf.

I hereby authorize TRIO TS to contact and request information from, as well as to share information with, the above mentioned parties both while my child is a participant and afterwards when in college. I give my son/daughter permission to participate in TRIO TS activities if accepted. Our signatures below indicate our commitment to the TRIO TS Student & Parent Agreement.

To the best of my knowledge, all the information I have provided in this application is true.

TRIO TS uses interviews, photographs and video of participants for use in marketing and promotional materials – print, audio, and digital – and documentation. If you want your child excluded from these materials, please contact our office at (360) 623-8969 or email us at TS@centralia.edu.

 

The TRIO TS project is 100% federally funded at $475,976 annually.

 

STATEMENT OF CONFIDENTIALITY: The information you provide in this application is confidential according to the Family Rights and Privacy Act. The U.S. Department of Education has the authority to gather the information requested in this application (20 USC 1231a). The only persons authorized to examine the contents of this application are the student, their parents, employees at the school attended, and authorized TRIO TS staff.

Student Needs Assessment 

Please help us get to know you better by answering the questions below.