Application for: Summer 20____ Fall 20____ Spring 20____
To qualify, you must meet each of the following criteria:
1. Be a California resident or AB540 eligible, as determined by Admissions & Records
2. Be enrolled or plan to be enrolled as a full time student (12+) units, with the exception of DSPS students
3. Have fewer than 70 degree applicable units completed, including coursework completed at other colleges
4. Qualify for the California College Promise Grant (CCPG) A or B (formerly known as BOGFW A or B)
5. Demonstrate an educational disadvantage, which is determined by your responses on this application
___________________________________________________________ ____________________________
Last Name First Name M.I. Student ID
___________________________________________________________ ____________________________
Street Address Apt # Phone Number
___________________________________________________________ ____________________________
City State Zip Date of Birth
E-mail address: ________________________________________________________________________________
Asian/Pacific Islander White/Caucasian
Hispanic/Mexican American/Latino/Central American
Other ________________
American Indian
Black/African American
Marital Status: Single
Divorced Married Other
Gender: Male Female
Are you or your children (under the age of 18) currently receiving TANF/CalWORKs (cash-aid assistance)?
__ Yes __ No
Are you currently enrolled with Disabled Students Program and Services (DSPS)? __ Yes __ No
1. Have you ever been an EOPS student at SBVC or at another community college? __ Yes __ No
If yes: Name of College: ____________________________________________________________
2. Have you ever attended any college other than SBVC? __ Yes __ No
If yes, list names of colleges here: _________________ _________________ _________________
**Official transcripts are required for each college you attended besides San Bernardino Valley College.
Please provide your transcripts for all schools attended to the EOPS office or to Admissions & Records. **
3. In total, how many units have you completed in college? _____________
4. How many units are you planning to take next fall or spring semester? _____________
5. How many units are you planning to take this summer? _____________
6. What is your educational goal? Transfer without an AA/AS Degree Transfer with an AA/AS Degree
Certificate Graduate with an AA/AS Degree Other
7. What is your intended major? _____________________________________________________________
1. Are you a resident of California? __ Yes __ No
2. Have you applied for the 2020/2021 FAFSA or for the 2020/2021 CA Dream Act? __ Yes __ No
3. What was the total annual income reported on your FAFSA or CA Dream Act application? $ ____________
4. What was the family size reported on your FAFSA or CA Dream Act application? ______
5. As of today, has the SBVC Financial Aid Office informed you of your eligibility for the 2020/2021 CCPG A or B
(CA College Promise Grant Fee Waiver)? __ Yes __ No
1. What level of math and English are you currently eligible to enroll in? Math ______ English______ Not sure
2. Did you graduate from high school or earn your GED? __ Yes __ No
3. Was your GPA lower than 2.5 in high school? __ Yes* __ No
*If yes, you must submit high school transcripts with cumulative/final GPA.
4. Have you previously been enrolled in basic skills classes in high school or college? __ Yes* __ No
*If yes, transcripts that include basic skills coursework must be submitted.
5. Special admit criteria as allowed by California Education Code and the State Chancellor’s Office:
Please check all which apply to you below:
I am a first generation college student where neither of my parents has earned a bachelor’s degree in the U.S.
English is not the primary language spoken in my home.
The language spoken in my home is_______________.
I am a current or former foster youth and can provide documentation.
Please read this statement before signing: I certify that all of the information on this application is accurate and
complete. I understand that providing false information or not properly disclosing all requested information will result in
immediate dismissal from the EOPS Program, should I be accepted. I further understand that the EOPS Program will fully
verify my economic eligibility with the Financial Aid Office. If it is determined that I do not meet all eligibility criteria, EOPS
will immediately discontinue providing services.
__________________ ___________________________________________________________
Student Name Date
For Office Use Only:
__ Approved __ Denied Semester Accepted into EOPS __________
Educational Eligibility Criteria: 1 2 3 4 5 Student Equity Underrepresented Target Group
MIS Input (initial) _______ Date: _______
____________________________________________________ ______________________
EOPS/CARE Director Date
Revised 5/29/19