Extended Opportunity Programs and Services
Student Application
14000 Fruitvale Ave, Saratoga, CA 95070
Phone: (408) 741-2023 http://westvalley.edu/eops
I. PERSONAL INFORMATION
Name:
Student ID:
Street Address:
City: State: Zip:
Phone Number: Email:
Ethnicity: Have you ever been in Foster Care? Yes No
Marital Status: Single (never married) Married Divorced Separated Widowed
Educational Goal: Transfer without AA/AS Transfer with AA/AS Vocational Ed Degree
AA/AS Degree Certificate Major:
Have you registered for Fall 2019? Yes No Number of Units Enrolled:
Are you participating in any other program at West Valley? Check all that apply
CalWORKS DESP First Year Experience Puente Success TRIO Veterans
II. INCOME
Have you completed the 2019-20 FAFSA to apply for Financial Aid?
Yes No
Are you receiving the California College Promise Grant? Yes No
III. EDUCATIONAL HISTORY
Highest level of education: High School Graduate Non-High School Graduate BA /BS degree
High School GPA:
Please list all Colleges/Universities attended and provide transcripts:
Total Units Completed at ALL colleges:
Are you a first generation college student (parents did not graduate college in the U.S.)? Yes No
Is English the primary language spoken at home? Yes No
IV. CARE ELIGIBILITY
Are you a Single Parent on Cash Aid /TANF
Number of dependent children: Age of dependent children:
SIGNATURE: DATE:
EOPS Director: Date: Approve: Deny:
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