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- 2020-2021 CAMP Application (3) (Chemeketa Community College)

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Office number: 503.589.7778 • Website: go.chemeketa.edu/camp
CHEMEKETACOMMUNITYCOLLEGE
C o l l e g e A s s i s t a n c e M i g r a n t P r o g r a m
2020–2021Application
TheCollegeAssistanceMigrantProgram(CAMP)isafederallyfundedprogramthat
supportsstudents
frommigrantand/orseasonalfarmworkerbackgroundsduringtheir
firstyearincollege.Theprogramprovides
supplementalfinancialassistanceandsupport
services,withthegoalofpreparingthemtocontinuetheir
educationandearnadegree.
Completeapplicationpacketscanbemailedordeliveredto:
CollegeAssistanceMigrantProgram
ChemeketaCommunityCollege

Building2,Room230
POBox14007

Salem,OR97309‐7070
Prioritydeadline:Friday,March6,2020
AdditionalcopiesoftheCAMPApplicationcanbedownloadedfrom
go.chemeketa.edu/camp
Office number: 503.589.7778 • Website: go.chemeketa.edu/camp
CAMP Eligibility Requirements
1.
Either the student or one of his/her parents must have worked as a migrant/seasonal farmworker
at least 75 days in the past 24 months. This includes any activity directly related to the production
of crops, dairy products, poultry or livestock; the cultivation or harvesting of trees including
nursery
and forestry work; or fish farm work
or
be eligible to participate or have participated in (a) The Migrant Education Program (MEP)
or
participated in the National Farmworker Jobs Program (NFJP) of Section 167 of the WIA
2.
Have a high school diploma or GED certificate
3.
Be in the first year of college undergraduate studies (minimum WR080, RD080, MTH020 through the
Placement Test or the Alternative WR/RD Test)
4.
Must be a U.S Citizen or U.S. Permanent Resident
5.
If accepted must be enrolled full-time, at least 12 credits per term (fall, winter, spring)
ChemeketaCommunity College is an equal opportunity, affirmative action institution. To request this document
inanalternateformat,pleasecontact
StudentAccessibilityServicesat503.399.5192(V/TTY),orstudentaccess@chemeketa.edu.
CAMP Application Packet Requirements
Completed CAMP Applications must include the following:
1. CAMP Application
2. Personal Statement
(1-2 pages typed in English). Tell us what challenges you are facing
going into college and/or what needs (academic, personal, financial) you may have.
3.
Copy of
High School/GED Transcript
4.
Copy of
Chemeketa Placement Assessment
OR Alternative WR/RD
Assessment (if necessary)
5. Proof of Migrant/Seasonal Farm work Eligibility
Option 1: Copy of Certificate of Eligibility (COE) from the Migrant Education Program (Request from MEP
Liaison at your high school)
or
Option 2: Copies of recent check stubs if applying as migrant seasonal farmworker eligibility (student and/or
parents)
or
Option 3: Copies of W-2s from last 2 years (only if requested by CAMP)
*CheckstubsorW‐2smustmeetEligibilityRequirementsasspecifiedonnumber#1ontheEligibilityRequirementsSection.
6.
Copy of
Student Aid Report (SAR)
for 2020 – 2021 from Free Application for Federal Student Aid (FAFSA)
•
Priority Deadline: Friday, March 6, 2020
•
Only students with completed applications will be interviewed.
Office number: 503.589.7778 • Website: go.chemeketa.edu/camp
2020‐2021CAMPApplication
PERSONALINFORMATION(PLEASEPRINTINBLUEORBLACKINK)
First Name
Last Name
KNumber
Date of Birth
Address
City
State
Zip Code
Cell phone
Home/Message phone
Chemeketa Email
Personal Email
ResidencyStatus:U.S.CitizenU.S.LegalPermanentResidentOther____________________________________
*CAMPeligibilityrequiresU.S.CitizenshiporU.S.LegalResidency
MIGRANTELIGIBILITY 
Have you or your parents been employed as migrant/seasonal farmworkers
at least 75 days in the past
24months?
Yes No
Have you ever participated in the Migrant Education Program (K-12)? Yes No
Have you ever participated in the National Farmworker Jobs Program (NFJP) of Section167
of the WIA? Yes No

EDUCATION
Date you received, or expect to receive your high school diploma or GED certificate:_________/_________
Month Year
High school diploma earned from: ______________________________________________________
Have you ever been enrolled in college? Yes No
If yes, name of college(s) attended:
_____________________________________________
If yes, how many credits earned?
______________

Have your parents ever attended college?
Yes No
Who?____________________Where?____________________________________________________
IcertifythatIhavehonestlyandtruthfullyansweredallquestionstothebestofmyknowledge.Iunderstandthat
anyfalseinformationprovidedmayleadtotheterminationofmyparticipationintheprogram.
Bysigning,Igive
consenttotheCAMPstafftocheckwiththeMEPofficeifIam/wasintheprogramMigrantProgramandrequestacopyof
theCertificateofEligibility(COE).
Applicant’sSignature
:____________________________________________________Date:_________________
UnderageStudents:Ifyouareundertheageof18,yourparent/guardianmustsignbelow.
Parent/Guardian’sSignature:
________________________________________________Date:_________________
ChemeketaCommunityCollegeisanequalopportunity,affirmative action institution. To request this document
inanalternateformat,pleasecontactStudent
AccessibilityServicesat503.399.5192(V/TTY),orstudentaccess@chemeketa.edu.
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- 2020-2021 CAMP Application (3) (Chemeketa Community College)

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Completed 26 July 2020

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