The TRiO Student Support Services Program is federally funded by the U.S. Department of Education. Our mission is to promote the retention, graduation and transfer of college students. All services are provided at no cost to qualifying students.

Students who desire to participate in the program’s activities must meet certain requirements established by the Department of Education (Higher Education Act of 1965). By completing this form, we will be able to accurately determine your eligibility and collect statistical data required by law. 

 If you require assistance, please contact our office at 209-588-5066. Applications are collected year round.


General Information:
First Name *
Middle Name
Last Name *
Student ID (W#) *
Date of Birth *
Age *
SSN Number
Local Address *
Address 2:
Local City *
Local State *
Zip *
Home Phone
Cell Phone Number *
Student Email Address *
Personal Email Address:

Demographic Information: (Required for federally funded grants; statistical use only, NOT used for eligibility)
Gender *
Gender Identification/Expression

*Please indicate yes or no for each of the following ethnicities. (Ethnicities defined according to federal definitions)

Hispanic *
American Indian or Alaskan Native *
Asian (including India, Pakistan, and Phillipines) *
Black or African American *
Hawaiian or other Native to Pacific Island *
White (including Middle East, North African) *
Other (please specify)

Educational Information (All questions must be answered)
Year of High School Graduation or GED
How many college units have you completed to date? *
How many college units are you enrolled in this semseter? *
Current College GPA *
Other Colleges/universities attended (names and dates)
Have either of your parents (that raised you) completed a bachelors degree? *
What services can the TRiO Program provide for you?
What are your educational goals? List all that apply ( 2-year AA/AS, Transfer to a 4-year university, undecided)
Are you a participant in any other Special Program on campus? Please list all that apply (EOPS, DSPS, CalWORKS, Veteran, Foster Youth)

Eligibility Questions:
Are you a US Citizen? *
If not a citizen, are you a legal permanent resident? *
Do you have a verifiable disability? *
Are you eligible for financial aid? *

Financial Aid and Yearly Income Totals (All questions must be answered)
When did you last apply for financial aid? (FAFSA or through financial aid on campus)
Are you an Independent student? (Same as the FAFSA) *
Are you a Dependent student? If yes, a parent MUST sign this application (Same as FAFSA.) *
Are you receiving a Pell Grant? *
Are you receiving a CCPG fee waiver? (Formerly known as BOGG) *
Are you receiving a Cal Grant/Completion Grant? *
Please list any other financial aid that you are receiving:
What is the total number of persons in your family (claimed in your household for taxes) *
My family's taxable income from last calendar year was (Can be found on line 14 of 1040 tax form):
I attest my family did not file a Federal Income Tax Return for last calendar year. Therefore, I attest my family's income was:
I attest that my family had no taxable income last calendar year

Read and Sign: I understand that my acceptance to the Student Support Services Program depends on the accuracy of my answers. I declare that the information on this form is true to the best of my knowledge. Pursuant to the Family of Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99), the TRiO Department Staff (SSS and MEOC grants) are authorized to access information deemed necessary to assist me in achieving my educational goals and in meeting the reporting requirements of the U.S. Department of Education for both the SSS and MEOC grants. This includes but is not limited to: determining eligibility in the program, services rendered, verification of secondary education completion and post-secondary education enrollment and completion, access my transcripts, financial aid awards, transfer school information, and disability verification through the college departments.

This information is protected by FERPA, kept confidential and not to be seen unless specifically authorized. Written authorization is required from the student to release this information to non-college officials, including parents, regardless of age of the student.

Note: This application will be automatically submitted. Please check your student email for the next steps for enrollment into the SSS and/or MEOC programs.


Student Signature *
Please select a signature verification type.
Parent Signature (required for ALL Dependent students)
Please select a signature verification type.