Extended Opportunity Programs and Services (EOPS)
Cooperative Agencies Resources for Education (CARE)
2017-2018 Application Page 1 of 2
STUDENT INFORMATION:
NVC Student ID# or
Name __________________________________________________ Social Security # ________________________
Last First MI
Address _________________________________________________________________________________________
Street City State Zip
Email (please PRINT) ______________________@__________________________ Date of Birth ____/_____/_______
Contact phone # ( _____)____________________________
MARITAL / FAMILY STATUS:
Marital Status: Single (never Married) Married Divorced Separated Widowed
Ethnic Background: (Please select ONE PRIMARY ethnicity)
African American Asian Caucasian/White Hispanic/Latino Filipino
Middle Eastern Native American Unknown Other _______________
How many dependent children do you have? (if applicable) _____ List the age of each dependent: ____________
Are you a Foster Youth or former Foster Youth? Yes No
Are you a veteran of the U.S. Armed Forces? Yes No
RESIDENCY STATUS:
Current Resident Status: U.S. Citizen Eligible non-Citizen AB540
None of the above, please explain: ______________________________________
FINANCIAL INFORMATION:
Have you completed the 2017-18 Free Application for Federal Student Aid (FAFSA) or Dream Act Application?
Yes No If No, please do so immediately or complete a BOGFW (Board of Governors Fee Waiver) application.
Do you currently receive services or resources from any of the following?
TANF CalWORKs Vocational Rehabilitation DSPS TRiO-SSS HSI/STEM Umoja Puente
EDUCATIONAL HISTORY:
High School Graduation Status: High School Diploma G.E.D. C.H.S.P.E. Non-graduate
High School GPA: __________
Is English your first language? Yes No
Did either of your parents graduate from college with a four-year degree (B.A., B.S.)? Yes No
Have you taken the NVC college assessment / placement tests in English, Math or ESL? Yes No
Have you previously attended Napa Valley College? Yes No
Have you attended any other college, university, vocational, technical or trade school? Yes No
If you attended other colleges, have you submitted transcripts to NVC? Yes No
List ALL colleges, universities, vocational, technical or trade schools in which you have enrolled after high school:
Name of School
Year(s) Attended
Number of Units Completed
Total number of units completed at all colleges to date: ___________ (if more than 70, you are not EOPS eligible)
Do you have a college degree? Yes No If yes, type of degree: ___________________________________
Did you participate in EOPS at another college? Yes No If yes, please list college(s): ______________________
EDUCATIONAL / CAREER GOALS:
What is your major? __________________________ What are your career goals? ______________________________
Do you plan to transfer? Yes No If yes, to what school? __________________________________________
Please indicate in which semester(s) you plan to enroll at NVC: Fall 2017 Spring 2018
STUDENT AUTHORIZATION AND CERTIFICATION:
(Please read and initial the items below):
_______I authorize EOPS staff to exchange information from other college departments and/or public agencies as it
relates to my eligibility or academic progress.
________ I certify that the information provided on this application is true and correct to the best of my knowledge.
________ I understand that I must enroll in at least 12 units at NVC to qualify to join EOPS, unless I have a documented
disability with DSPS.
________ I understand that priority enrollment is given to students who are not being served by similar NVC academic
support programs.
________ I understand I will be notified by email, phone, or mail regarding my eligibility for EOPS. If any of my contact
information changes, I will notify the EOPS office of any changes.
___________________________________________ _______________________________
Applicant Signature Date Signed
Return completed application to:
Financial Aid/EOPS Office
Napa Valley College
2277 Napa-Vallejo Hwy.
Napa, CA 94558
If you have questions regarding EOPS and/or this application, please contact the NVC EOPS office at (707) 256-7310 or (707) 256-7300.
Fax (707) 256-7309
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