Fillable CalWORKs File Update To assist us in making (El Camino Community College District)

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CalWORKs File Update To assist us in making (El Camino Community College District)

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The El Camino Community College District is committed to providing an educational and employment environment in which no person is subjected to discrimination on the basis of actual
or perceived race, color, ancestry, national origin, religion, creed, age (over 40), disability (mental or physical), sex, gender (including pregnancy and childbirth), sexual orientation, gender
identity, gender expression, medical condition, genetic information, marital status, military and veteran status, or retaliation; or on any other basis as required by state and federal law.
Updated June 2018
CalWORKs File Update
To assist us in making sure our records are complete, please fill out the information below.
Semester: __________________ Student ID#: _____________ GAIN Case Number: _______________
Name: __________________________________________________________________________________
Last First M
Your GAIN workers name: ______________________________________ Phone#: _________________________
Are you currently working? Yes No
If yes, where: _____________________________________ How many hours? __________ Pay rate: $_______
OFFICE USE ONLY
CW FILE:
EVENT DB:
CARE: ☐YES ☐NO
☐ REFERRAL
What services will you need to help you be successful at El Camino College?
Job Placement
Health Services
Tutoring
Personal/Psychological Counseling
Child Care
Testing for Learning Disabilities
Is your Financial Aid up-to-date?
Yes No Do not qualify
Are you in the CARE program? Yes
Never Applied Do not qualify
Are you taking classes at the Compton
Center this semester?
Yes No
Current marital status:
Single (never married) Married
Separated Divorced
Widowed
List all of the dependent children under your direct care below:
Full Name of Child
Age
Relationship to You
Please complete this portion if you recently changed your contact information
Address: ______________________________________________________________________________
Street City Zip
Phone: ___________________________________ Cell Phone: ________________________________
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CalWORKs File Update To assist us in making (El Camino Community College District)

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Completed 28 August 2021

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