Educational Information
Program Information
High School Diploma
GED
Non-High School Graduate
Other:
Have you participated in EOPS in the Educational Goal: (Check all that apply) Please state your intended college major
past? or certificate program atWCC/LCC/CCC:
Yes
Associate Degree (A.A. or A.S.)
No
Transfer Major:
If yes, at what college?
Certificate Other:
Please indicate the highest level of
Was your high school GPA 2.49 or lower? If yes, please attach your high school transcript.
Yes
No
education completed by your
Have you completed any units in the Yuba Community College District?
Includes any courses taken at WCC, LCC, CCC and YCC campus locations.
Yes
No
parents: Mother Father
None
Have you earned any degrees or certificates? If yes, please state the degree, subject and year:
Yes
No
Elementary
High School
Have you attended any colleges outside the Yuba Community College District?
If yes, please attach all transcript(s)
Yes
No
Some College
Associates Degree
Bachelor’s Degree
Master’s Degree
Demographic Information
Sex: Have you lived in CA for at
Ethnicity:
Caucasian
Latino
Asian American
Pacific Islander
African American
Native American/
Alaskan Native
Filipino
Armenian
East Indian
Russian/Ukrainian
Decline to state
Other:
Primary language
spoken at home:
least 1-year + 1 day?
Male Yes
Female
No
Have you submitted the following documents to Financial Aid for the current year?
FAFSA BOG Fee Waiver
Are you a former foster youth or ward of the court that can provide verification?
Are you a part of the Disabled Students Programs & Services?
N/A
Yes No
Former DSPS
Current DSPS
Will apply for DSPS
If you are a participant, please attach a unit certification letter from the DSPS office.
Are you a part of the Woodland Community College CalWORKs program? N/A Former CalWORKs Current CalWORKs Will apply for CalWORKs
This section is for an additional program called CARE. If you meet the CARE criteria listed below, please fill-out the following questions. If you
are not eligible, you may skip this area and proceed with the final section of the application.
CARE eligibility criteria
Be eligible and admitted into EOPS
Be at least 18 years of age
Single parent/head of household
Have at least one child
A copy of your C
ounty Eligibility
Verification or current
TANF/CalWORKs Verification Form is
required when applying for CARE.
“Success is about being your best self, not about being better than others; failure is an opportunity, not a condemnation; effort is the key to success.”
2020-04-20; ah
Carol S. Dweck, Ph.D.
EOPS/CARE Programs Woodland Community College
Application for Admission
Academic Year 20202021
Use Blue or Black Ink
Last name:
First name:
Student ID:
Personal Email Address:
Cell Phone:
Home Phone:
How did you hear
about our
programs?
Website
Brochure
Staff/Faculty
Friend/Family
Address:
City:
State:
Zip:
□ Class Presentation
Name of College or University Outside the Yuba Community College
Total Units Completed
Transcript Attached
Yes
No
Parent must be a CalWORKs/TANF recipient
Are you receiving TANF/CalWORKs cash aid benefits for yourself?
Are you a single parent or head of household?
Yes
No
If no, are your children receiving cash aid?
Yes
No
Which county are you receiving aid?
What is your marital status?
Number of dependent children:
1 2 3 4 5 6+
Single
Married
Divorced
Separated
If married, are you considered the head of household by your county’s
department of Social Services?
Yes
No
Do you have at least one dependent child that is 13 years of age or younger?
Yes
No
____________________________________________
Use Blue or Black Ink
Please provide responses below. Your application is considered complete only if you respond to all three items.
Thoroughness of answers will be reviewed as part of the admissions process for the program.
1.
What do you know about EOPS/CARE and the services our programs can offer you?
2.
Why do you want to be an EOPS/CARE student at Woodland Community College (Woodland, Lake or Colusa Student?)
3.
Briefly describe your short and long term educational or career goals.
Student Learning Outcomes
Please answer the following questions to the best of your ability; there is no penalty for answering Maybe, Not Sure or No.
\
SLO I: Can you, with confidence, state all of the campus support services and community resources available to you?
Yes
Maybe
Not Sure
No
SLO II: Can you, with confidence, state all of the educational requirements necessary for you to reach your educational goal?
Yes
Maybe
Not Sure
No
EOPS/CARE Staff Received:
Staff Signature: Date:
“Success is about being your best self, not about being better than others; failure is an opportunity, not a condemnation; effort is the key to success.”
Carol S. Dweck, Ph.D.
Student Authorization and Signature
With my signature below, I acknowledge that I have carefully reviewed the content of this application, and certify that the information
contained herein is true and complete to the best of my knowledge per penalty of perjury I
also realize that any false statement or failure
to give proof when asked may be cause for the denial, termination, and/or repayment of EOPS/CARE services or equivalent cost
for
services. I authorize the sharing of information regarding this application between Woodland Community College EOPS/CARE, the Yuba
Community College District, the Chancellor’s Office of the California Community Colleges and Yolo, Lake and/or Colusa county
social
service agencies, as applicable. I understand that I can be removed fr
om this program if I fail to comply with program guidelines, county
requirements, fail to progress academically, or at WCC EOPS/CARE discretion. Lastly, I understand that services provided by t
his
program are contingent upon available funds.
Student Signature: Date:
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