TRiO Application
Please complete the following form and Press the Submit button.

* Completion of field is required. Use NA if the field does not apply.
Last Name *
First Name *
Middle Initial *
Date of Birth *
Age *
Local Address *
City *
State *
Zip *

Permanent Address

Home Phone *
Work Phone *
Cell or Message Phone *
CNM Email *
Which mode of contact preferred *
Gender *
High School Diploma *
Have you been awarded a Asociate's or Bachelor's Degree *
College Status *
Term Enrollment *

The USDE requires institutions to collect data on race and ethnicity:

Do you consider yourself Hispanic/Latino

Select one or more races listed and check Yes or No.

American Indian-Alaskan Native
Black or African American
Native Hawaiian/Other Pacific Islander

CNM Program of Study (Major) *
Are you pursuing an Associate’s Degree
Do you plan to transfer to a 4- year university
Are you a U.S. Citizen or Permanent Resident

Are you a first generation college-student? (While you were growing up Parent(s) or guardian(s) did not have a 4-year college degree)

What is the highest level of education COMPLETED by the parent(s) or guardian(s) you grew up with? *

Mother/guardian *

Father/guardian *

Do you have a Physical or Learning Disability
If yes, are you registered with Disability Resource Center for accommodations
Have you applied for Financial Aid at CNM this year*
If yes, what type of financial aid are you receiving*

If you have not applied for Financial Aid at CNM, are you ineligible*

Do you receive funding from any of the following sources (Check all that apply) *


CNM Campus attending (check all that apply) *

Are you presently attending a 4-year University *

What are your future College plans? (Check one) *

How did you find out about CNM TRiO Student Support Services *
Referred by *
Reference phone or email *
Please check if you have participated in any of the following TRiO programs *

If so, where and when
Why are you interested in becoming a TRiO member? *
What resources will you use the most? *
Given the TRiO has limited enrollment, is there any additional information you want us to know that would help us distinguish you from other applicants. *
List Participation in CNM student organizations/clubs *
Indicate the areas of assistance you are interested in receiving *


In order to provide quality assistance to you, we ask for your participation. Please complete the following:

I, , certify that all the information provided on this form is correct and complete to the best of my knowledge. I give permission for the release of my CNM educational records in reference to academic transcripts, degree plans, and testing/assessment scores, and any other pertinent information related to my educational endeavors to the TRiO Student Support Services staff of Central New Mexico Community College.

I agree to the above and I have read and will comply with the student TRiO participation contract *

The CNM TRiO Student Support Services program has a limited student enrollment. In the event of an opening, staff will contact applicant to schedule a selection interview appointment and will require additional information. Thank you for your interest in TRiO Student Support Services at CNM.

Central New Mexico Community College
1401 Basehart Rd. SE
TRiO Student Support Services, Basehart Temporary Room 4
Albuquerque, NM 87106
Phone: (505) 224-4375

This program is 100% grant funded by the U.S. Dept. of Education under the Higher Education Act of 1965.

Today's Date *