Submit Your Application to Pacific University's TRIO Student Support Services program

Thank you for your interest in our TRIO Student Support Services program at Pacific! 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 information, and then return to submit your application.

If you have any questions, please feel free to drop by Clark 327, email TRIO@pacificu.edu or call us at (503) 352-2746.

PLEASE NOTE: This form asks for sensitive information that will be stored with a third party service provider and will be reported to the federal Department of Education. Please contact us if you have any questions or concerns about data security.

General Information:

First Name: *

Preferred First Name:

Middle Name:

Last Name: *

Pronouns:

Pacific ID Number: *

Date of Birth: *

Mailing Address: *

City: *

State: *

Zip Code: *

Pacific Email Address: *

Cell Phone Number:

Do we have permission to text you? *

Demographic Information:

Are you Hispanic or Latino? *

Per federal regulations: Hispanic/Latino/a/e/x refers to a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.

What is your race? (Select all that apply)

American Indian or Alaskan Native

Asian

Black or African American

White

Native Hawaiian or Pacific Islander

What is your US Citizenship Status?

What is your legal sex? *

While we respect the gender identity of all students, we are required to report "Legal Sex" as part of federal requirements.

Eligibility Information:

Are you currently working towards your first Bachelor's degree? *

Do either of your parents or guardians have a 4-year Bachelor's degree? *

Do you have a documented disability, as verified by the Office of Accessibility & Accommodations? *

Please select your eligibility criteria *

Tell us about your interest in the TRIO program. What support are you hoping to receive? *

Education Information:

Current Grade Level: *

Major(s) and/or Minor(s): *

Current Cumulative GPA:

What is your current academic standing?

How many classes are you taking?

Family Information:

Parents highest level of education:

How many people are in your household at home?

Family Income Range:

This would be your family's taxable income. This can be found on US Individual Income Tax Return - IRS Form 1040, see Line 15. NOTE: family is defined as anyone who claims you as a dependent on their taxes regardless of your age. If you are an independent student, you must enter your taxable income information just for yourself.

It is okay to provide your best estimate at this time, as we will verify this information.

Sign and Submit:

Applicant Signature *

Please select a signature verification type.

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.