TRiO Application

TRiO Participant Application

FIELDs MARKED WITH "*" ARE REQUIRED

Part 1: Personal Data

*Student S Number:   *Required Field
*Student First Name:   *Required Field
*Student Last Name:   *Required Field
Mailing Address:
City:       State:       Zip Code:
*Primary Phone Number: *Required Field
Work Phone Number:   
Cell Phone Number:   
Can we send you text messages?:  
*Email Address: *Required Field
*Gender   *Required Field

Part 2: Ethnicity/Race/Citizenship Group

*Are you of Hispanic, Latino and or Spanish Origin?
   *Required Field
*Are you a U.S. Citizen?
   *Required Field
Are you an eligible non-citizen? Alien Registration Number:
  
*What is your race? One or more categories may be selected
  





*Required Field

Part 3: Marital Status

*What is your Marital Status?
*Required Field
     
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For more information please contact:

  

Holly Lewis

Holly Lewis
TRiO Director

Questions? Contact:
Holly Lewis
Wheeler 120
Phone: 719-384-6835
Holly.Lewis@ojc.edu