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

First Name
Please let us know your name.
M.I.
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Last Name
Please let us know your name.
K Number
 (K00000000 if unknown)
Invalid format! Your School ID must begin with a K and then have 8 numbers (eg., K11111111).

Date of Birth

Date format:
"mm/dd/yyyy"

Review the date format
Example:09/22/1960
Gender
Please, make a choice.

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.

Ethnicity

(Choose one.)

Please chose one option.

Race

(Choose one or more.)

Please, make at least one choice.

Address
Please, provide your street address.
City
Please, provide your city of residence.
State
Please, provide your state of residence.
Zip
Please, provide your zip code.

Cell ( - Invalid Input Invalid Input   Invalid Input Ok to text cell phone? Invalid Input Alt. Phone ( - Invalid Input Invalid Input   Invalid Input

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

Eligibility

Please answer all questions on each part of this application before selecting the "Submit" button.
Have either of your parents completed a 4-year degree (bachelor's degree)?
Please, make a choice.
Do you have a learning, physical or psychological disability including but not limited to ADD/ADHD, anxiety, depression, PTSD, chronic illness?
Please, make a choice.
If you have a disability, have you submitted documentation to Student Accessibility Services?
Please, make a choice.
Are you a United States citizen?
Please, make a choice.
If not a United States citizen, are you a permanent resident?
Please, make a choice.
Resident Alien Number (if not applicable, leave blank)
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Goals

Please answer all questions on each part of this application before selecting the "Submit" button.
Do your educational goals include earning an Associate's Degree?
Please, make a choice.
Are you enrolled in an Associate's degree program at Chemeketa?
Please, make a choice.
Which program or degree are you planning to complete at Chemeketa?
Please, provide an intended program of study.
Do you plan to transfer for a Bachelor's degree?
Please, make a choice.
If you plan to transfer, which college do you plan to attend?
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Background

Please answer all questions on each part of this application before selecting the "Submit" button.
Did you graduate from high school with a standard diploma?
Please, make a choice.
What was your High School GPA? (if not applicable, leave blank)
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Did you earn a modified high school diploma?
Please, make a choice.
Did you earn a GED?
Please, make a choice.
Have you attended any other colleges or universities?
Please, make a choice.
If Yes, what was your college GPA? (if not applicable, use 0.0)
If not applicable, use 0.0
Please provide the names of any other college you have attended?
(if not aplicable, use "None")
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How many college credits have you completed? (if not applicable, use 0)
(if not applicable, use 0)
Have you ever been on academic warning in college?
Please, make a choice.
Have you ever been on financial aid warning?
Please, make a choice.
Are you receiving financial aid?
Please, make a choice.
Is English your second language?
Please, make a choice.
How long have you been out of school
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Do you need advice for transfer planning?
Please, make a choice.
Have you participated in TRIO, CAMP, Talent Search, or Upward Bound before?
Please, make a choice.
If you have participated in TRIO, CAMP, Talent Search or Upward Bound before, which program and school? (if not applicable, leave blank)
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Financial

Please answer all questions on each part of this application before selecting the "Submit" button.
Were you born before January 1, 1997
Please, make a choice.
Are you currently or have you been married?
Please, make a choice.
Are you, or were you, an orphan or ward of the court?
Please, make a choice.
Do children live with you and receive more than 1/2 of their support from you?
Please, make a choice.
Do you provide more than 1/2 the support for other dependents living with you?
Please, make a choice.
Are you a veteran of the US Armed Forces?
Please, make a choice.
How many people live in your household?
Please, make a choice.
Family TAXABLE Income $
Provide your family's taxable income in whole dollars.
Taxable income is not the same as gross or adjusted gross income. Look at the following lines on your taxes for last year: Form 1040 -line 43, Form 1040A - Line 27, Form 1040EZ - Line 6.

Preferences

Please answer all questions on each part of this application before selecting the "Submit" button.
How many credits will you take per term
Please, make a choice.

Essays

Please answer all questions on each part of this application before selecting the "Submit" button.
1. What challenges do you expect to face while completing college? (Your answer must be at least 6 sentences)
The essays are required.
2.What motivates you to go to school?
(Your answer must be at least 6 sentences)
The essays are required.

How did you hear about TRIO or CCP?
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TRIO Student Support Services are 100% federally funded at $585,436 annually.

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