___
___
STUDENT SIGNATURE DATE
SAN DIEGO CITY COLLEGE
EXTENDED OPPORTUNITY PROGRAMS AND SERVICES (EOPS)
1313 PARK BLVD., ROOM A-354, SAN DIEGO, CA 92101
Office (619) 388-3209 ~ Fax (619) 388-3163 ~ Email cityeops@sdccd.edu
2019-2020 New Student Application
CSID# First Name MI Last Name
Address City State Zip
Email
Phone
Date of Birth
1.
Income you receive - (Check all that apply)
Employment TANF/CalWORKs
Social Security Income Other
2.
Marital Status (check one): Single
Married
Divorced
3.
Ethnicity (Optional)
4.
Are you a current or former Foster Youth? Yes No
If yes, is your age between 18 and 26
Was your dependency/wardship established/continued on or after your 16
th
birthday?
5.
Do you have a High School Diploma or GED?
6.
Have you completed any college courses?
Yes No
Yes No
High School GPA
7.
Have you completed the San Diego City College Admissions Application? Yes No
8.
Number of units you plan to take: Fall 2019 Spring 2020
9.
Have any of your parents earned a 4-year college degree? Yes No
If you answered “Yes” what is that person’s relationship to you?
10.
Have you completed the 2019-2020 Free Application for Federal Student Aid (FAFSA) or CA Dream Act? Yes No
11.
Have you attended other colleges outside of our District? Yes No
If you answered “Yes” please provide information for ALL colleges that you attended. Transcripts for these colleges must be submitted
directly to the San Diego Community College District for official evaluation.
College Name
Dates Attended
Units Completed
Were you an EOPS Student?
Yes No
Yes
No
THIS SECTION FOR EOPS STAFF USE ONLY.
NEW/CONT RES YES NO (0F) # OF UNITS FALL SPRING <12 (0J) GPA:
R/W/M: / / ; CUM UNITS REM UNITS >70 (0H) <6 SEM YES (0K) NO #
OF SEM ED DISADV YES A=ENG/MAT B=NHS C=<2.5HSPA D=(REM) E=OTHER NO (0I)
CCPG/BOG = Yes
____
No
(0G); FA FILE COM/NC; OU PCK ___/___
TECH DATE
COMMENT
REVISION: OU CHANGED TO BY DATE
DIR’S APPROVAL: YES NO REASON INITIAL & DATE
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