10. Student Type
First time- never attended College First time at COS previously attended another college
Continuing from last semester Returning to COS after an absence of one or more years
K-12 Student (You must complete the attached Permit to Register)
11. Name of Last High School Attended & Graduation Date
High School: Graduation Date: _____________ State: _____________
The following information must be answered each term for reporting purposes
12. Educational Objective for Term
Associate & Transfer Improve basic skills Move noncredit to credit coursework
Transfer without Associate Advance in career/update skills Mtg 4-yr college req-4-yr student
Associate Degree Maintain certification/license Undecided on goal
Certificate of Achievement Educational Development Uncollected/Unreported
Discover Career Interest/Goal Credits for HS diploma/GED
13. Residency Questions
Have you continuously lived in California for the past two years? Yes No
If no, specify state/country: Dates:
If no, length of time in California:
What is your Driver’s License #? State:
Do you have a vehicle? Yes No
If yes, in what state is your vehicle registered?
Do you intend California to be your permanent residence? Yes No
Have you done any of the following in the past two years?
Voted in another state or registered to vote in another state? Yes No
If yes, what state?
Attended out-of-state college/university as a resident? Yes No
Did you file California State Income Taxes for the past calendar year? Yes No
Students under 19 years old and unmarried ONLY
Are your parents or guardians California residents and continuously lived in California for the past two years?
If yes, when did your parents enter California: / /
Month Day Year
14. Are you on any of the following economic assistance programs?
General Assistance None
15. Are you a single parent with custody of a minor child? Yes No
16. Are you a displaced homemaker? Yes No
17. Are you a migrant worker or child of a migrant worker? Yes No
18. Are you or parent/guardian an honorably discharged Veteran? Yes No
Student Military Status Parent/Guardian Military Status
Currently serving on active duty Currently serving on active duty
Member of the Active Reserve Member of the Active Reserve
Member of the National Guard Member of the National Guard