Oregon State University-Cascades-SSS-Application Form

TRIO Student Support Services-OSU Cascades
Thank you for your interest in the TRIO Student Support Services (TRIO SSS) program at Oregon State University Cascades Campus. Please complete all parts of this application to the best of your ability. Note that you will be required to input yours or your family's taxable income (depending if you are dependent or independent for FAFSA purposes), therefore we recommend you gather your income tax documents before you begin this application. If you have any questions with this application or if you have questions about admission into our program, please contact Amy Davila-Klautzsch at Amy.Davila-Klautzsch@oregonstate.edu
Student Name*

First NameMiddle InitialLast Name
What are your pronouns?
OSU student ID number*
Phone*
(999)999-9999
ONID OSU email address*
example@example.com
Alternate email address*
example@example.com
Best way to contact you (check all that apply) :*

EmailTextPhone
Date of Birth*

MonthDayYear
mm-dd-yyyy
Gender*

MaleFemalePrefer not to answer
What is your U.S. Citizenship Status?*

U.S. CitizenPermanent ResidentNone of the above
Resident ID #*
At this time, TRIO Student Support Services is unable to admit students to the program who are non-residents due to Department of Education guidelines. If you have any questions, please contact Amy Davila-Klautzsch at Amy.Davila-Klautzsch@oregonstate.edu.
Are you a resident of Oregon?*

YesNo
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Ethnicity: Do you identify as Hispanic or Latino?*

YesNo
Race: Please select the racial categories with which you identify (If you are admitted into the program, we will have to complete racial information for you (even if you selected an ethnic identity of Hispanic or Latino above). So this question is required in order to continue your application.)*

American Indian/Alaskan Native - American Indian/Alaskan Native refers to a person having origins in any of the original peoples of North and SouthAmerica (including Central America), and who maintains tribal affiliation or community attachment.Asian - Asian refers to a person having origins in any of the original peoples ofthe Far East, Southeast Asia, or the Indian subcontinent, including, forexample, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, thePhilippine Islands, Thailand, and Vietnam.Black or African American - Black or African American refers to a personhaving origins in any of the black racial groups of Africa. Terms such as"Haitian" or "Negro" can be used in addition to "Black or African American."White - White refers to a person having origins in any of the original peoplesof Europe, the Middle East, or North Africa.Native Hawaiian or Other Pacific Islander - Native Hawaiian or Other PacificIslander refers to a person having origins in any of the original peoples ofHawaii, Guam, Samoa, or other Pacific Islands.
Major*
Current GPA (H.S. or college)*
First term at OSU (select the term you start(ed) at OSU and write the year)*

FallWinterSpringSummer
Year*
Current year in college*

FreshmanSophomoreJuniorSenior
Are you a transfer student?*

YesNo
Please list all colleges/universities that you have previously attended: *
Has it been five or more years since you last attended college?*

YesNo
Did you get a high school diploma or a GED?*

High school diplomaGEDOther
Have you previously been in a TRIO program?*

YesNo
What TRIO program were you in?*

Upward BoundTalent SearchStudent Support ServicesOther
At what institution were you in a TRIO program? *
Official Annual household taxable income for the most recent tax year(it is important that you do not estimate these numbers). For both the 2023 and 2024 1040 tax form, this number can be found on line 15.*
Number in Household*
(Effective January 15, 2025 until further notice)
The term "low-income individual" means an individual whose family's taxable income for the preceding year did not exceed 150 percent of the poverty level amount.

The figures shown under family income represent amounts equal to 150 percent of the family income levels established by the Census Bureau for determining poverty status. The 2025 poverty guidelines are in effect as of January 15, 2025. Federal Register notice was published January 17, 2025.

Federal TRIO Programs -- Current-Year Low-Income Levels

(Effective January 11, 2024 until further notice)

Size of Family Unit	48 Contiguous States, D.C., and Outlying Jurisdictions	Alaska	Hawaii
1	$22,590	$28,215	$25,965
2	$30,660	$38,310	$35,250
3	$38,730	$48,405	$44,535
4	$46,800	$58,500	$53,820
5	$54,870	$68,595	$63,105
6	$62,940	$78,690	$72,390
7	$71,010	$88,785	$81,675
8	$79,080	$98,880	$90,960

For family units with more than eight members, add the following amount for each additional family member: $8,070 for the 48 contiguous states, the District of Columbia and outlying jurisdictions; $10,095 for Alaska; and $9,285 for Hawaii.

Federal TRIO Programs -- Current-Year Low-Income Levels

(Effective January 19, 2023 until further notice)

Size of Family Unit	48 Contiguous States, D.C., and Outlying Jurisdictions	Alaska	Hawaii
1	$21,870	$27,315	$25,155
2	$29,580	$36,960	$34,020
3	$37,290	$46,605	$42,885
4	$45,000	$56,250	$51,750
5	$52,710	$65,895	$60,615
6	$60,420	$75,540	$69,480
7	$68,130	$85,185	$78,345
8	$75,840	$94,830	$87,210

For family units with more than eight members, add the following amount for each additional family member: $7,710 for the 48 contiguous states, the District of Columbia and outlying jurisdictions; $9,645 for Alaska; and $8,865 for Hawaii.

Program Eligibility, please select all that apply:*

First generation student (your parent(s) or legal guardian(s) who raised you did not have a degree from a four year university)Student with documented disability (Please be prepared to provide documentation)Low income based on the Federal TRIO program guideline (see LI table above).
As a reminder, even if you don't live with your parents, they don't support you financially, or claim you on their taxes, you are still considered a dependent student unless one of the following is true (please specify):*

24 years old or olderMarriedHas childrenDependents other than child/spouse who live with you and receive at least half of their support from youCurrently serving on active duty in the U.S. armed forces for purposes other than trainingVeteran of the U.S. armed forcesAt any time since turning age 13, both parents are deceased, you were in foster care, or you are a dependent or ward of the courtEmancipated minor or in a legal guardianshipUnaccompanied youth who is homeless or at risk of being homelessNone of the above
If you are a dependent student and submitted your parents' financial information when you completed the FAFSA, they will need to verify the above information (annual household taxable income and number in household). Please have them review this information, and sign in the box below.
I, as the PARENT OR LEGAL GUARDIAN of the applicant, verify that to the best of my knowledge, the annual household taxable income and number in household (answered above) are accurate. By typing my full name below I am signing this application. *

Parent First NameParent Last Name
To help us understand a little more about who you are and why you’re interested in our program, please briefly explain what motivated you to apply for TRIO SSS at OSU and what services you expect will benefit you the most.*
I hereby apply for admission to the Oregon State University TRIO Student Support Services program (TRIO SSS). If I am admitted to TRIO SSS, I understand that I will remain a TRIO SSS student for up to six (6) years until I graduate and/or leave the university. The information I provided is accurate and true, to the best of my knowledge. By typing my full name below I am signing this application. *

First NameLast Name

TRIO Student Support Services-OSU Cascades