STEP and PTO Student Assessment Form - Central Oregon Community College

First Name*

Last Name*

Email Address*

Student ID Number*9 digit number (ex: 820123456)

Phone Number *

Reason for This Request

What particular resource do you need at this time and how will it help your education?For example: books, tuition, fees, food etc.

Current COCC Program

Desired COCC Program

Have you applied for FAFSA/ORSAA?

Are you receiving SNAP benefits?

What is your primary language?

How were you referred to our services?