Thank you for your interest in the Coconino Community College TRIO Student Support Services program! 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 and gather the required documents, and then return to submit your application. If you have any questions, please email our office at



Student Information
First Name *
Last Name *
Middle Name
Comet ID *
@ ID Number *
Date of Birth (00/00/0000) *
Cell Phone Number *
Alternate Phone
Email Address *
Legal Gender *
Preferred Pronoun(s)
Marital Status
Do you identify as Hispanic or Latino/a? *
Race (choose all that apply), American Indian or Alaskan Native *
Race (choose all that apply), Asian *
Race (choose all that apply), Black or African American *
Race (choose all that apply), Hawaiian or other Native to Pacific Island *
Race (choose all that apply), Hispanic *
Race(choose all that apply), White *

Eligibility Criteria

*Funding is provided by the US Department of Education and requires specific documentation for enrollment into the Student Support Services program. The information is protected by the Family Educational Rights and Privacy Act (FERPA).

Student Residency Status: Are you a U.S. citizen, U.S. national, or U.S. permanent resident? *
Social Security Number (REQUIRED for verification of residency) *
Are you registered with CCC’s Disability Resources Office for a physical, mental, or learning disability? *
Has either of your parents (natural or adoptive) received a bachelor’s degree (4-year college degree)? *
Were you in foster care at any time since you turned age 13? *
Academic Need
Academic Need *
Education Information
Have you received your: *
High School GPA
Have you previously attended college or taken college courses in high school? *
Did you graduate with an Associate Degree or higher? *
What are your academic goals? *
What would you link to major in? *
What is your career goal? *

Income Verification

*Verification requirements for TRIO vary depending on whether students are independent or dependent. A list of federal criteria for independent student status is available at:

Information for the most recent tax year, 2020.

I was an independent student (typically age 24 or older, married or emancipated; parental income is not reported on the FAFSA). Complete Part A.
I was a dependent student (younger than 24, unmarried/not emancipated; parent income IS reported on FAFSA). Complete Part B and have parent sign.

Part A: Independent Students Only

(no parent information required)

^Taxable Income: Form 1040 line 15. If taxes were not filed, please report total income from all sources.

Total Number In Family:
Taxable Income^:

Part B: Dependent Students

(Parent information required)

^Taxable Income: Form 1040 line 15. If taxes were not filed, please report total income from all sources.

Total Number In Family
Taxable Income ^:
Dependent Student Parent/Guardian Signature
Please select a signature verification type.

I certify that all of the information I have provided is true and accurate and complete to the best of my knowledge.

I understand the Coconino Community College TRIO Student Support Services Program (SSS) is funded by the U.S. Department of Education. All information is strictly confidential and is used solely for the purpose of determining eligibility of students applying for participation.

Students are accepted to the SSS program based on eligibility criteria, academic need and space availability. All applications are accepted for review regardless of race, color, national origin, religion, gender, or disability (U.S. Dept. of Education-GEPA Section 427).

I hereby authorize the CCC TRIO SSS program to obtain, copy, review, and discuss my student and financial records with the appropriate CCC staff, faculty and college departments as pertinent to my participation in the program. I also give my permission to receive notifications from TRIO SSS via text messaging and to be interviewed and/or photographed by the TRIO SSS program for use on marketing/advertising and promotional materials.

My signature below indicates my commitment to the TRIO Student Support Services program.

Please select a signature verification type.