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Thank you for your interest in the TRIO Student Support Services Program! Please complete this application as thoroughly as possible. You cannot save and restart this application at any time. If you have any questions, please call or text 937.328.6122, or email carydevinec@clarkstate.edu.
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Describe your primary reason for applying:
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Please check this box if you have a documented disability. This is one of three qualifying eligibility criteria to be in the TRIO program. A disability may be physical or emotional such as ADHD, anxiety, PTSD or depression.
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If you have a disability, have you applied for accommodations through the Office of Accessibility Services at Clark State?
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Ethnicity:Â Check all that apply
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Race, American Indian or Alaskan Native
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Race, Hawaiian or other Native to Pacific Island
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Race, Black or African American
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Please indicate the degree or certificate you plan to complete at Clark State.
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Please indicate if you want to complete a degree or a certificate at Clark State
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Have you been out of school for five or more years?
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Check this box if you earned a GED.
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Did you participate in any of the following programs?
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Parent/Guardian Educational Level:
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How many people in your household at home?
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Most Recent IRS 1040/Income Verification Form
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Were you at any time in the foster care system, or in kinship care with relatives or other known adults?
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Terms of Submission:
By submitting this application, you acknowledge that all of the above information is correct and accurate to the best of your understanding.
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Please select a signature verification type.
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What is the best way to contact you?
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