Instructions

This application approves students for three different programs. It's okay if you find yourself answering no to many questions. Your answers help us to identify which program is best suited to you as an individual.

It takes about 20 minutes to complete and cannot be saved. Please answer all questions before submitting. If you'd like to work on the essays in a Word or Google Doc, you can copy and paste them into the application before submitting. To request this in an alternative format or to request a disability accommodation, please call 503.399.5192

Please be careful to use only number characters when being asked to enter a number. Do not enter 1,000 enter 1000.

Feel free to call our office at 503.315.4293 if you need assistance. We look forward to receiving your application!

General

Please let us know your name.

Invalid Input

Please let us know your name.

Invalid format! Your School ID must begin with a K and then have 8 numbers (eg., K11111111).
Review the date format
Example:09/22/1960
Please, make a choice.



Please, provide your street address.

Please, provide your state of residence.

Please, provide your city of residence.

Please, provide your zip code.


Primary Phone:

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Invalid Input

Alternate Phone:

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Please, provide your Chemeketa E-mail. The email should be in the form of: "user@my.chemeketa.edu."

Please let us know your email address.

Eligibillity

The following two part question on ethnicity / race follows The U.S. Dept. of Education requirements. More information can be found here.
Ethnicity / race Definitions can be found here.

Please chose one option.

Please, make at least one choice.

Please, make a choice.


Please, make a choice.


Please, make a choice.

Please, make a choice.

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Goals

Please, make a choice.

Please, make a choice.

Please, provide an intended program of study.

Please, make a choice.

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Background

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Invalid Input

Please, make a choice.

Please, make a choice.

Please, make a choice.

If not applicable, use 0.0

Invalid Input

(if not applicable, use 0)

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Please, make a choice.

Please, make a choice.

Please, make a choice.

Invalid Input

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Please, make a choice.

Invalid Input

Financial

Please, make a choice.

Please, make a choice.

Please, make a choice.

Please, make a choice.

Please, make a choice.

Please, make a choice.

Please, make a choice.

Provide your family's taxable income in whole dollars.
Please, make a choice.

Preferences

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Essays

Please answer the following questions: Responses must be at least 6 sentences each. Your application will NOT be considered without fully completed responses.

The essays are required.

The essays are required.

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Submit

Acceptance Required to Submit

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Application cannot be submitted without the above certification and agreement.

Please contact the Chemeketa Community College Student Support Services Office for further information.


TRIO Student Support Services are 100% federally funded at $585,436 annually.
A signature and date is required

Human Verification Invalid Input

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TRIO Student Support Services are 100% federally funded at $585,436 annually.

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