Centralia College-SSS-Application Form
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  • TRIO Eligibility Criteria

    1. If you are/will be a student at Centralia College.
    2. Be a U.S citizen or permanent resident.
    3. Meet at least one of the following:
      • Be a first generation college student (neither of your parents have a four year college degree)
      • Federal low-income eligibility requirements (usually if you qualify for a Pell grant)
      • Have a documented disability.
    4. Be enrolled in 5 college-level credits or be following college placement.
    5. Plan to graduate from Centralia College, within 3 years.
    6. Do not currently have an Associate degree or higher.

    Instructions

    Please complete all questions.

    You will be asked to sign the application. Sign with your finger if your device allows. Otherwise, sign with your mouse/mouse pad.  Edge and Firefox browsers seem to work the best for touch-screen finger signing.

    We look forward to receiving your application! Feel free to call our office at (360) 623-8770 if you need assistance or if you need an alternative format.

    • General 
    • Have you earned an Associate (2 year) degree or higher?*
    • Are you in Running Start?*

    • We are not currently accepting Running Start students. No need to continue this application. Please reapply once you have finished Running Start. Please call us if you have any questions at 360-623-8970

    • Since you have a degree, you do not need to complete this application.  Please call us for an appointment at 360-623-8970

    • Date of Birth*
       - -
    • Gender*

    • **As a program we recognize some students may not identify with either option.  However, as a federally-funded program we are required by the U.S. Department of Education to report gender and currently these are the only two options.

    • Ethnicity: Do you identify as Hispanic/Latino?*
    • Race (Check all that apply to you – definitions below)***
    • American Indian/Alaskan Native*
    • Asian*
    • Black/African American*
    • White*
    • Native Hawaiian/Other Pacific Islander*
      • American Indian/Alaskan Native - American Indian/Alaskan Native refers to a person having origins in any of the original peoples of North and South America (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 of the Far East, Southeast Asia, or the Indian subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
      • Black/African American -  Black or African American refers to a person having origins in any of the black racial groups of Africa, including Haitian.
      • White - White refers to a person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
      • Native Hawaiian/Other Pacific Islander - Native Hawaiian or Other Pacific Islander to a person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

      **As a program we recognize some students may not identify with these options. However, as a federally-funded program we are required by the U.S. Department of Education to report race and currently these are the only options

    • OK to text cell phone?
    • The best way to contact me:*
    • Eligibility 

    • Please answer all questions on each part of this application before selecting the "Submit" button.

    • Have either of your parents completed a 4-year degree (Bachelor's degree)?*
    • Have you ever been in Foster Care?*
    • Do you have a documented disability?*
    • If you have a documented disability, have you submitted documentation to the Disability Services Office?*
    • Are you a United States citizen or Permanent Resident?*
    • Are you registered for 5 or more college level credits [100 level or above] or following college placement?*
    • Goals 

    • Please answer all questions on each part of this application before selecting the "Submit" button.

    • Do you plan to graduate from Centralia College?*
    • Do plan to transfer for a bachelor's degree?*
    • Background 

    • Please answer all questions on each part of this application before selecting the "Submit" button.

    • Did you earn a high school diploma?
    • Did you earn a GED?
    • Have you attended any other colleges or universities?*
    • Have you received college credits through high school?
    • Have you ever been on academic warning in college?
    • Have you ever been on financial aid warning?
    • Will you be receiving financial aid for school this coming year?
    • Is English your second language?
    • Have you participated in TRIO, CAMP, Talent Search, or Upward Bound at Centralia College?
    • Have you ever been in TRIO STUDENT SUPPORT SERVICES at Centralia College?
    • When was the last time you were enrolled in school? (High School or College)*
    • Financial 

    • Please answer all questions on each part of this application before selecting the "Submit" button.

    • Have you completed the FAFSA?*
    • As of Dec 31st of this year will you be 24 years or older?*
    • Are you currently or have you been married?*
    • Are or were you an orphan or were you a ward of the court until age 18?*
    • Do children live with you and receive more than 1/2 of their support from you?*
    • Do you provide more than 1/2 the support for other dependents living with you?*
    • Are you a veteran of the US Armed Forces?*
    • Are you a McKinney-Vento student(Documented homeless youth)?*

    • Signature Page - 2024/2025 Academic Year
      Financial Eligibility Confirmation for Dependent Students
      Form must be completed by parent.


      Step 1. On the chart below, select the number of people in your household.
      Step 2. Look at the taxable income figure across from the number you selected in step 1.
      Step 3. If your taxable income from 2022 taxes was less than the number in step 2,
      select “less.” If it was more, then select “more.”


      *Note: taxable income is not the same as your gross income or adjusted gross income (AGI). When looking at your taxes for the 2022 tax year, taxable income is typically found on the following lines: (Form 1040—line 43; Form 1040A—line 27, Form 1040EZ—line 6.)

    • Step 1 & 2 (# in your household and Last year's taxable income)
    • Step 3 (Was your income less or more)

    • Statement: By signing this statement I certify that, to the best of my knowledge, the above information (submitted online and printed here) is accurate and I am willing to provide tax forms or other needed documentation in order to verify this information.

    • Date:
       - -

    • Signature Page - 2024/2025 Academic Year
      Financial Eligibility Confirmation for Independent Students


      Step 1. On the chart below, select the number of people in your household.
      Step 2. Look at the taxable income figure across from the number you selected in step 1.
      Step 3. If your taxable income from your 2022 taxes was less than the number in step 2, select “less.” If it was more, then select “more.”


      *Note: taxable income is not the same as your gross income or adjusted gross income (AGI). When looking at your taxes for the 2022 tax year, taxable income is typically found on: (Form 1040—line 11b.)

    • Step 1 & 2 (# in your household and Last year's taxable income)
    • Step 3 (Was your income less or more)

    • Statement: By signing this statement I certify that, to the best of my knowledge, the above information (submitted online and printed here) is accurate and I am willing to provide tax forms or other needed documentation in order to verify this information.

    • Date:
       - -
    • Additional Info - Final Questions 

    • We use this information to identify the best ways we can serve you as a participant.  Please take your time answering the questions.

    • How did you hear about TRIO Student Support Services?*
    • I certify that to the best of my knowledge, statements I have made on this form are complete and true. Failure to disclose and submit complete and accurate information may result in the denial of acceptance to the Centralia College Student Support Services program. I also understand participation in Student Support Services requires program access to my student records both at Centralia College and intended transfer institutions. I approve release of my grades, transcripts, financial aid information, test results, and any other information related to my educational endeavors to CC Student Support Services, from entities including, but not limited to, Financial Aid, Admissions/Registrar’s Office, National Student Clearinghouse, etc., with the assurance that the information will be held in the strictest of confidence and in accordance with FERPA.*
    • I authorize the Centralia College Student Support Services to use any interviews, pictures, or videos of me in program approved publications such as brochures, radio, TV, print media, recognition awards, newsletters or other promotional materials and/or documents.*
    • Submit 
    • Should be Empty: