Applicant Information
Thank you for your interest in our Student Support Services program! 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 documents, and then return to submit your application. If you have any questions, please call our office at 541-440-4712
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Do you plan to transfer to a 4-year institution?
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Do you have a documented physical or learning disability?
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Are you currently enrolled in at least 12 credit hours at UCC?
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Has your parent or guardian earned a Bachelor's Degree from a 4-year institution?
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If yes, did you regularly reside and receive support from them?
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Ethnicity (optional): Do you identify as Hispanic or Latino?
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Race:Â Check all that apply
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American Indian/Alaskan Native
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Support Services (please check all that apply)
At the Transfer Opportunity Program, we firmly believe in providing the best services possible to ensure student academic needs are being addressed. Our program participants are provided with a variety of services. Please indicate the service(s) below that you feel would be most beneficial to your academic success.
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Cultural Events (plays, museum tours, etc)
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Have you ever Participated in a TRIO program?
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Have you ever particpated in a UCC program?
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Income Verification Step 1
The following questions will help the Transfer Opportunity Program determine if you meet federal low income guidelines.Â
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Are you married or separated but not divorced?
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Do you have any dependants who receive more than half of their support from you?
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At any point since you turned 13, were you in foster care?
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Are you a US Armed Forces Veteran or currently serving on active duty?
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Do you have independent status with financial aid?
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Income Verification Step 2
If you are less than 24 years old and you answered NO to all questions in Step 1, please use your family taxable income to answer the following questions.
If you are at least 24 years old or you answered YES to any question in Step 1, please use only your taxable income.
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Federal Low-Income GuidelinesÂ
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Were you 24 years old or older as of December 21 of last year?
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Indicate your family's federal taxable income for the prior year.
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I attest that my family did not file a federal income tax return for the last calendar year. Please complete the NON-TAX FILER STATEMENT form (available in the TOP office).
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Have you applied for Financial Aid for the current academic year?
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I hereby certify, to the best of my knowledge, that all the information submitted is complete and correct. I understand that
the information that I provide the Transfer Opportunity Program (TOP) will be kept confidential and follow the rules and
policies of Umpqua Community College. I authorize the TOP to obtain, copy, and/or review my educational and financial
records as needed. I understand that failure to disclose accurate information may be grounds for dismissal from the
program. I also give the TOP permission to give my name, address, transcript, and the information in this application to
other educational institutions or organizations that may be interested in providing me with educational or financial
opportunities upon my acceptance/enrollment into the program.Â
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Sign and Submit
If you are less than 24 years old and you answered NO to all questions in Step 1, both you and a parent or a guardian, must sign below.Â
If you are at least 24 years old or you answered YES to any question in Step 1, only your signature is required.
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Please select a signature verification type.
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Parent or Guardian Signature
Please select a signature verification type.
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