From last September to today, have you participated in any other TRiO program? *
Ethnicity: Are you Hispanic/Latino? *
American Indian or Alaska Native
Black or African American
Native Hawaiian or Other Pacific Islander
Two or more races
Are you a U.S. citizen? *
Does your parent/guardian have a 4-year college degree? *
Are you proficient in English? *
Military Connections: *
Are you a Veteran? Yes No
Are you active duty military? Yes No
Are you the spouse of an active duty military person? Yes No
Are you the child of an active duty military person? Yes No
Independent (age 24 or older, or married, or a parent, or other) If other:
Dependent (I do not meet the Independent requirements)
1. How many individuals are supported by the household income (household size)? *
2. Enter your household's current income or taxable income from the last IRS tax form you submitted. *
3. Is it your intent to go on to earn a bachelor's degree? *
4. High School (check one): *
GED in progress
I do not have a HS diploma or GED
Current high school student (12th grade only) Enter name of your high school:
5. College (check one): *
Never attended college.
Prior college student.
Current college student.
I have a Certificate or AA degree.
6. I am interested in enrolling in college. *
7. I desire to enroll in college to pursue a degree/career in: *
8. because: *
9. I would like more information about and/or assistance with: *
a) GED® Preparation and Testing information
b) Admissions/College Application
c) Financial Aid/FAFSA Application
d) Scholarship Application
e) Student Loan Application
f) Other (e.g. Academic Advising, Career Information, Study Skills)
I hereby certify that this information is correct to the best of my knowledge. By checking the box below, I am granting all TRiO ROC and college personnel access to the information contained on this form and in the RCC system for the purposes of program recording, tracking, and reporting as required by the U.S. Department of Education. I allow TRiO ROC personnel to conduct research pertaining to my educational outcomes as they relate to the TRiO ROC program using phone, email or other digital mediums.
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Rogue Community College does not discriminate in any programs, activities, or employment practices on the basis of race, color, religion, ethnicity, use of native language, national origin, sex, sexual orientation, gender identity, marital status, veteran status, disability, age, pregnancy, or any other status protected under applicable federal, state, or local laws. For further policy information and for a full list of regulatory specific contact persons visit the following webpage: www.roguecc.edu/nondiscrimination.