Extended Opportunity Program Services
Email Application: firstname.lastname@example.org
First Name Student ID #
Date of Birth Phone #
Please answer all questions below to find out if you qualify for the EOPS program. YES NO
Are you an AB540 student or Deferred Action for Childhood Arrivals (DACA) recipient?
Have you applied for the California College Promise Grant and/or FAFSA?
Have you attended any other community college/university in the US or a foreign country?
Have you earned a bachelor’s degree or higher?
Was your high school grade point average less than 2.50?
Have you ever taken Basic Skills or Remedial courses in high school or college?
Is English the primary language spoken at home?
Have either of your parents earned a college degree?
Are you or were you ever a foster youth?
Are you a single parent head-of-household receiving cash aid for you and/or your child(ren)?
Are you receiving CalWORKs/TANF for yourself and/or your child(ren)?
I declare under penalty of perjury that all the information on this application is true and correct to the best of my knowledge and agree to submit
official high school and/or college transcripts, if
applicable, to the Admissions & Records Office. I give the EOPS Office permission to access financial and
academic history information in order to determine EOPS eligibility. I also understand that falsification or withholding information requested shall
constitute grounds for withdrawal from the EOPS Program. Family Educational Rights and Privacy Act (FERPA) allows schools to disclose records,
without consent, to the following parties or under the following conditions; school officials with legitimate educational interests, specified officials for
audit or evaluation purposes, appropriate parties in connection with financial aid to a student, ….(34 CFR 99.31).
By checking “I Accept”, I acknowledge and understand the above terms of Agreement: I Accept
EOPS is a program dedicated to deliver comprehensive student support services to all EOPS qualified applicants. The
program further strives to encourage the enrollment, retention, and transfer of students who have or are experiencing
language, social, economic, and educational disadvantages.
Complete the information on this application and email to "email@example.com" Please note that eligibility for
EOPS is not automatic. Eligibility is based on both INCOME and EDUCATIONAL DISADVANTAGE criteria. Submission of
this application is no guarantee of EOPS eligibility. To assist the staff in determining your eligibility, YOU MUST SUBMIT
ALL REQUIRED DOCUMENTATION WITH THIS APPLICATION (including other college and/or official high school
transcripts). You MUST have applied for FAFSA and/or California College Promise Grant.
(include international colleges/universities)
For which semester do you want to apply:
Fall 20___ Spring 20___ Summer 20___
What is your ethnic background?
Father's native language:
Mother's native language:
Transfer to university Certificate program