Student Assessment Form

To request assistance from COCC's Benefits Navigator (Thrive Central Oregon) or SNAP Training and Employment Program (STEP), please complete the form below as thoroughly as possible so our staff can best assess your needs. If you have not yet applied to COCC, please submit an admissions application or call 541-383-7500 to speak with an Enrollment Specialist.

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?