Thank you for your interest in our Student Support Services program at Blue Mountain Community College! Please complete this application as thoroughly as possible.

You cannot save and restart this application. You may want to review the included items. Take some time to make notes, gather the required documents, and then return to submit your application. If you need to edit the application after it has been submitted, please contact the TRIO Student Support Services office. 

If you have any questions, please call our office at 541-278-5855 or email trio@bluecc.edu or stop by. We are located in Morrow Hall 146.
                                                                                                            
General Information:
Last Name *
First Name *
Middle Name
Date of Birth *
Current Address: *
Permanent Address:
City: *
State: *
Zip: *
Permanent Phone:
Cell Phone Number: *
BMCC Email: *
Personal Email:
Student ID #: *
What pronouns do you prefer (e.g. she/her/hers; he/him/his, they/them/theirs)
                                                                                                            
Please answer the following questions:
Are you currently admitted or enrolled at BMCC? *
Did a parent or guardian earn a Bachelor degree from a university? *
Do you have a documented disability? *
Are you currently receiving accommodations at BMCC for a disability? *
Are you a US Citizen? *
If answered no above, Are you a permanent resident?
If not a US Citizen, are you a Documented Permanent Resident?
If yes, provide your Permanent Resident Card number
                                                                                                            
Ethnicity:
Are you Hispanic or Latino ethnicity? *
Race, American Indian or Alaskan Native *
Race, Asian *
Race, Black or African American *
Race, Hawaiian or other Native to Pacific Island *
Race, Hispanic *
Race, White *
                                                                                                            
Academic Info:
What is the highest level of education you have completed, or the highest degree you have received? *
What degree are you working toward? *
What are your educational and career goals? *
                                                                                                            
Income Verification Step:
Have you applied for financial aid for the 2023-2024 Academic School year? *
For Independent Students (24 years or older, married, or with dependents):
Did you (the student) file a 2022 tax return? *
Total number of people living in your household (including you)?

Note: If married and you did not file jointly, you must provide your spouses tax information.

Based on your 2022 tax return, please provide your TAXABLE INCOME. (Not total income) this can be found on Line 15 of the 1040 tax form. 
Students Taxable Income
                                                                                                            
For Dependent Students (Age 18-24), unless otherwise determined, you (the student) must provide your patent(s) tax information:
Did your Parent(s) file a 2022 tax return? *
Total number of people living in the household (including you):
Based on your Parents 2022 tax return, please provide your TAXABLE INCOME. (Not total income) this can be found on Line 15 of the 1040 tax form. 
Parents TAXABLE income
                                                                                                            

Sign and Submit:

I certify, that to the best of my knowledge, the information I provided on this application is true and correct. I authorize the TRIO SSS Program staff to obtain, copy and/or review my records, including, but not limited to, high school and college transcripts, test scores, financial aid records, final grades and enrollment status at any college or university, to determine eligibility for the program. 

 

 
Applicants Signature: *
Please select a signature verification type.
Parents Signature (If family income was provided)
Please select a signature verification type.