Fillable Form 1: C The California Community Colleges (Moorpark College)

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Form 1: C The California Community Colleges (Moorpark College)

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College:
___________________________________________________________
1
1.
2.
3.
4.
5.
6.
City (U.S. or Non-U.S.)
Mobile Phone
8.
Second Phone
The California Community Colleges
Application for Admission
Email Address
(California Community College)
Number
Area Code
Area Code
Number
Legal Last Name
Summer ____________
Winter /
Intersession __________
Legal Name
Use only your legal name as it appears on official legal or educational documents.
Suffix
No Legal
First Name
No Legal
Middle Name
digit SSID, enter here.
See Page 9 for information on where to find your SSID.
State / Non-U.S. Province
Country
Street Number
Street Name Apt. or Suite
City (U.S. or Non-U.S.)
ZIP Code / Postal Code
Current Mailing Address
If under 19 years of age, enter the address of your parent or guardian.
Street Number
Street Name
Apt. or Suite
ZIP Code / Postal Code
Country
I have no current mailing address; I am homeless.
I authorize text messages to be sent to the mobile phone number
above, and accept responsibility for any charges that result.
I authorize text messages to be sent to the second phone number
above, and accept responsibility for any charges that result.
9.
7.
NOTE: Text messaging may be used by the college in situations such as class cancellations, emergency notifications, and other campus alerts.
C
Section A: Enrollment / Account Information
California Statewide
Student ID (SSID):
If you know your ten
Fall __________
Term (Check one term only and enter the Year)
Middle Name
If you might have educational records under a different name, please enter full previous First, Middle and Last names here.
Previous Name
Do you have a preferred name that is different than your legal and/or previous name?
Previous Middle Name
Note: Not all colleges allow preferred names for official
academic uses due to legal or technical restrictions.
Preferred Last Name
Preferred First Name
Permanent Address
Preferred Name
Preferred Middle Name
State / Non-U.S. Province
An email address is required for important messages, including information about college admission and registration. Please enter an email address that you check regularly.
Previous Last Name
Legal First Name
CCCApply Application for Admission
Page 1 of 10
Previous First Name
College Student ID:
_____________________
Spring ________
If you are under 19 years of age, enter the address of your parent or guardian.
I have no permanent address; I am currently homeless.
2
11.
Section B: Personal Information
Your Name: _____________________________
I do not have a Social Security Number or Taxpayer ID Number, or decline to provide one at this time.
Social Security Number / Taxpayer Identification Number
Type:
Social Security Number
Taxpayer ID Number
I am an international student, nonresident alien, or other exception, and I do not have a Social Security Number or Taxpayer ID Number.
Parent /Guardian Name & Relationship
First Name:
Last Name:
Relationship:
Regardless of your age, please indicate the highest level of education attained by the parents and/or guardians who raised you.
Enter the corresponding number or letter into each box:
1 = Grade 9 or Less
2 = Some high school, did not graduate
3 = High school graduate (diploma, GED, or equivalent)
4 = Some college credit, no degree
5 = Associate degree (ex: AA, AS)
Parent / Guardian 1:
Mother
Guardian
Father
6 = Bachelor’s degree (Ex: BA, BS)
7 = Graduate degree (Master’s, Ph.D., or degree beyond Bachelor’s)
X = Unknown
Y = No parent or guardian raised me
Parent / Guardian 2:
Dependency Status Determination
By providing my Social Security Number (SSN) / Taxpayer ID Number (TIN) above, or by indicating that I do not have an SSN / TIN, or decline to provide one at this
time, I confirm that I have read and understand the federal laws stated below, and the state privacy laws and regulations provided in the Privacy Policy available to me
at any time at https://www.openccc.net.
Month Day Year
I am under 19 years old and none of the statements above are true about me.
I am or have been married.
I am legally emancipated.
I do not have a living parent or guardian.
As of the day before the first day of the term I am applying for, I am or will be on active duty in the armed services.
As of the day before the first day of the term I am applying for, I have been self-supporting for at least one year.
I am under 19 years old and at least one of the statements below is true about me:
If you are currently under 19 years of age, you must select the statement that applies to you:
By California law, qualification for resident tuition is based on the residency of your parent(s) or guardian(s) until you are 19 years of age, except in certain
special
circumstances.
The
following
questions
will
be
used
to
determine
whether
or
not
you
need
to
provide parent
or guardian
information
for
the
purposes
of
determining
residency.
Your
response
will
not
affect
your
admission
to
college.
The
campus
may
request
additional
information
prior
to
making
a
final
residency determination.
12.
13.
Parent /Guardian Education Level
IMPORTANT: If you answered "None of the statements above are true about me", you must provide information about your parent/guardian below and on all questions
in Section E: California Residency, p.5. For information on how to answer the residency questions in this application, see Appendix i: Information Section, on p.10.
14.
Birthdate
1
0.
The Social Security Number is required to claim tax credits for higher education costs known as the American Opportunity Tax Credit in accordance with the Taxpayer Relief Act of
1997. Federal law requires the California Community Colleges to provide specific information to the Internal Revenue Service (IRS) for the purpose of filing an information return
(IRS Form 1098T “Tuition Statement”) for each student in attendance, with a few exceptions.The information required by the IRS includes the student’s name, address, Social
Security Number (SSN) or Taxpayer Identification Number (TIN/iTIN), and enrollment status, as well as the amount of tuition paid or billed, and scholarships received. (26 C.F.R.
1-60505-1(b)(2)(ii).) Failure to provide a correct Social Security Number or TIN while claiming tax credits for specified education expenses may result in a penalty levied against the
student by the IRS in the amount of $100, per year, until the missing or incorrect information is provided (26 C.F.R. 160505-1(e)(4))
Page 2 of 10
Birthdate information is used to differentiate between persons having the same name. It is also used to
comply with state and federal laws pertaining to residency, guardianship, and admission of minors to
college. This information will not be used in making admissions decisions except as permitted by law.
•
•
•
•
•
Need Help? OpenCCC Helpdesk Call: 877-247-4836 Email: support@openccc.net
Required only for applicants under 19 years of age.
Revision 12.12.16
Asian: Indian
Asian: Chinese
Asian: Japanese
Asian: Korean
Asian: Laotian
Asian: Cambodian
Asian: Vietnamese
Asian: Hmong
Asian: Other - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent.
Black or African-American: A person having origins in any of the black racial groups of Africa.
3
Mexican, Mexican-American, Chicano
Central American
South American
Hispanic: Other
Your Name: ________________________________
Gender information is used for state and federal reporting purposes. It is optional and voluntary and will not be used for discriminatory purposes.
"Gender" in this context, means a person's sex, or a person's gender identity and gender expression.
Female
Male
Decline to state
Race & Ethnicity
What is your race? Check one or more:
Gender
Section B: Personal Information (Continued)
15.
16.
17.
Are you Hispanic or Latino? A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
If yes, you must check one or more:
CCCApply Application for Admission
Page 3 of 10
The U.S. Department of Education requires colleges to collect racial and ethnic data but are prohibited from discriminating on the basis of race,
color, or national origin, in all programs or activities that receive federal financial assistance. Ethnicity is sensitive information, protected by
federal law and the Office of Civil Rights. It is used primarily by agencies affiliated with state reporting and evaluation of educational programs.
American Indian
Pacific Islander: Guamanian
Pacific Islander: Hawaiian
Pacific Islander: Samoan
Pacific Islander: Other - A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
White: A person having origins in any of the original peoples of Europe, the Middle East, or North America.
American Indian/Alaskan Native - A person having origins in any of the original peoples of North and South America (including Central
America) who maintains cultural identification through tribal affiliation or community attachments.
Revision 12.12.16
4
U.S. Citizen
Permanent Resident
Temporary Resident
Refugee / Asylee
Student Visa (F1 - M1)
Other
Citizenship Status
Alien Registration Issue Date
Alien Registration Expiration Date
No Documents
If you are not a U.S. Citizen, please enter the following:
Alien Registration Number
Enter your 7-9 digit Alien Registration Number
No Expiration Date
Section D: U.S. Military / Dependents of Military
Military Status
Please select your U.S. military status:
None apply to me
I am currently serving on active duty
My parent/guardian/spouse is currently serving on active duty
I served in the U.S. military (veteran)
My parent/guardian/spouse served in the U.S. military (veteran)
I am a member of the Active Reserve
My parent/guardian/spouse is a member of the Active Reserve
I am a member of the National Guard
My parent/guardian/spouse is a member of the National Guard
Type of Discharge:
Month Day
Year
Honorable
Other than Honorable
Entry Level Separation (ELS)
Bad Condu
ct (BCD)
General
Dishonorable
Please enter the military member's State of Legal Residence _____________________________________
Stationed in California?
Is the military member currently stationed in California? Yes No
Is the military member's assignment in California for educational purposes for 30 days or more?
Check here if no
expiration date
Section C: Citizenship
Visa Issue Date
Visa Expiration Date
If you don't know your Visa type, please refer to the Admissions Office at the college you are applying to.
Visa Type :
Enter your Visa Type below:
Type: __________________________
If you have a student Visa, please circle the type below:
Student Visa: F1 M1
19.
20.
21.
22.
23.
24.
25.
Clemency
18.
Please enter the military member's Home of Record ____________________________________________
If the Home of Record is in a foreign country, enter the Country of Record __________________________
Yes No
Month Day
Year
Month Day
Year
Your Name: _____________________________
Month Day
Year
M M D D Y Y Y Y
Month Day
Year
State of Legal Residence:
Home of Record:
If you, or your parent/guardian/spouse, served in the U.S. Military, please enter the following information:
Date of Discharge:
M M D D Y Y Y Y
M M D D Y Y Y Y
M M D D Y Y Y Y
M M D D Y Y Y Y
Page 4 of 10
Need Help? OpenCCC Helpdesk: Call: 877-247-4836 Email: support@openccc.net
Revision 12.12.16
Are you or your parent or guardian a full-time credentialed employee of a California public school
enrolling in college for purposes of fulfilling credential-related requirements?
5
Your Name: ________________________________
Have you or your parent or guardian lived in California continuously for the last two years?
When did your or your parent's or guardian's CURRENT stay in California begin?
M M D D Y Y Y Y
Check this box if you or your parent or guardian have not yet arrived in California, or do not plan to relocate to California.
Section E: California Residency
Your responses to the following questions are required to make a preliminary assessment of your California residency status for admission and tuition fee
purposes. The college may request additional information prior to making a final residency determination. NOTE: If you answered "Yes" to “Dependency
Status Determination” (Question #12 on page 2), you must answer the following questions based on your parent or guardian’s information. For more
information about how to answer the questions below, see Appendix i: Information Section on p. 10.
Are you or your parent or guardian a full-time employee of any of the following colleges/universities?
California Community College
California State University or College
University of California
Maritime Academy
Have you or your parent or guardian been employed as a seasonal agricultural worker for at least a total
of two months of each of the past two years?
Have you ever been in court-ordered foster care?
If yes, when did you exit
foster care?
I am currently in foster care (including extended foster care after age 18).
I aged out/emancipated from foster care or exited voluntarily on or after my 18th birthday.
I exited the foster care system before my 18th birthday.
I am not sure at what age I exited foster care.
In the last two years, have you or your parent/guardian declared residency in another state for state income tax purposes?
In the last two years, have you or your parent/guardian registered to vote in another state?
In the last two years, have you or your parent/guardian declared residency at an out-of-state college or university?
In the last two years, have you or your parent/guardian petitioned for a lawsuit or a divorce as a resident in another state?
No
Yes
No
Yes
26.
27.
28.
29
.
30.
31.
32.
33
.
34.
No
Yes
No
Yes
No
Yes
Yes
No
If Yes, what was the most recent year?
Y
Y Y Y
Yes No
If Yes, what was the most recent year?
Y Y Y Y
Yes
No
If Yes, what was the most recent year?
Y Y Y Y
Yes No If Yes, what was the most recent year?
Y
Y Y Y
35.
At any time in the last 24 months, have you been determined to be homeless by one or more of the following?
High school or school district homeless liaison
Emergency shelter or transitional housing program
Director of a runaway or homeless youth basic center or transitional living program
Yes
No
•
•
•
•
•
•
•
Month Day Year
CCCApply Application for Admission
Page 5 of 10
Revision 12.12.16
Your Name: ________________________________
Section F
: High School Education
A = Obtain an associate degree and transfer to a 4-year institution
B = Transfer to a 4-year institution without an associate degree
C = Obtain a 2-year associate degree without transfer
D = Obtain a 2-year technical degree without transfer
E = Earn a career technical certificate without transfer
F = Discover/Formulate career interests, plans, goals
G = Prepare for a new career (acquire job skills)
H = Advance in current job/career (update job skills)
Education Goal: Please enter the corresponding letter of your education goal in the box:
I = Maintain certificate or license
J = Educational development
K = Improve basic skills
L = Complete credits for high school diploma or GED
M = Undecided on goal
N = To move from noncredit coursework to credit coursework
O = 4-year college student taking courses to meet 4-year college requirements
First-time student in college (after leaving high school)
First time at this college; have attended another college
Returning student to this college after absent for a main term
Enrolling in high school (or lower grade) and college at the same time
College Enrollment Status: On the day before the first day of the Term you are applying for, what will your enrollment status be?
Intended Major: ___________________________________________________________
High School Education Level: On the day before the first day of the
term you are applying for, what will your high school education level be?
Received a high school diploma from a U.S. school
Passed a high school equivalency test and received a certificate of equivalency
Received a Certificate of California High School Proficiency
Received a diploma/certificate of graduation from a foreign secondary school
Currently enrolled in an adult school
Enrolled in high school (or lower grade) and college at the same time
Not a graduate of, and no longer enrolled in high school
High School Completion Date: Provide your high
school completion date, or the date you plan to complete
high school. If unsure of the date, please estimate.
Date of Completion:
Year
Month
Day
I attended high school.
I was homeschooled in a registered homeschool organization.
I was independently homeschooled.
I did not attend high school and was not homeschooled.
Other: __________________________________________
Last High School Attended:
No
Have you attended high school in California for
three or more years? Yes
No
Did you receive your diploma, GED, or certificate
in California?
Yes
U.S. State:
Last High School / Secondary School Information:
School Name:
City:
Country:
Non U.S. State Province
36.
37.
38.
39.
40.
42.
41.
43.
44.
6
ZIP Code/Postal Code:
M M D D Y Y Y Y
-
Page 6 of 10
Need Help? OpenCCC Helpdesk: Call: 877-247-4836 Email: support@openccc.net
Need Help? OpenCCC Helpdesk: Call: 877-247-4836 Email: support@openccc.net
Revision 12.12.16
Pre-algebra or lower
Algebra 1
Integrated Math 1
Integrated Math 2
Geometry
Algebra 2
Integrated Math 3
Statistics
Integrated Math 4
Trigonometry
Pre-calculus
Calculus or higher
None of the Above / Don't Know
7
Your Name
: ______________________________
Section G: High School Transcript Information
Highest English Course Taken
Please indicate the highest
English course you took in
high school?
Grade Point Average: What was your high school GPA (grade point average)? Please enter a value between 0.00
and 4.00 in the adjacent box. If you are still in high school, enter your cumulative GPA as of the end of 11th grade. If
unsure, please estimate.
No
Yes
Description
Title of Highest Courses Taken and Passed
Please CIRCLE your selection
What grade did you receive?
12th grade Advanced Placement (AP) English Composition or Literature
12th grade Honors English Composition or Literature
12th grade English Composition or Literature
11th grade Advanced Placement (AP) English Composition or Literature
11th grade Honors English Composition or Literature
11th grade English Composition or Literature
10th grade (or lower) English Composition or Literature
Highest Math Course Taken
Please indicate the highest
Math course you took in
high school?
If you are currently enrolled in
high school, this would typically
be in 11th grade or earlier.
None of the Above / Don’t Know
Pre-algebra or lower
Algebra 1
Integrated Math 1
Integrated Math 2
Geometry
Algebra 2
Integrated Math 3
Statistics
Integrated Math 4
Trigonometry
Pre-calculus
Calculus or higher
None of the Above / Don't Know
A- B+
B- C+
C- Pass
A
B
C
D F No Pass
Other Non-Passing Grade
None of Above
Don't Know
A A- B+
B B- C+
C C- Pass
None of Above
Don't Know
A- B+
B- C+
C- Pass
A
B
C
D F No Pass
Other Non-Passing Grade
None of Above
Don't Know
Highest Math Course Passed
Please indicate the highest
Math course you passed
with a Pass, C-, or better
grade, in high school
If you are currently enrolled in
high school, this would
typically be in 11th grade or
earlier.
Place
X
Completed 11th Grade? If you are in high school (or lower grade), please indicate if you have completed 11th grade,
otherwise skip to Grade Point Average.
45.
46.
Place an "X" in the box to the right to make your selection.
in box
.
CCCApply Application for Admission Page 7 of 10
If you are currently enrolled in
high school, this would typically
be in 11th grade or earlier.
College staff use this information to provide guidance. Your responses will not affect your admission to college.
Revision 12.12.16
8
College/University Name
Degree Date
Month
Year
State
Degree
City
Were you
Expelled?
Y or N
No Degree
Bachelor's Degree
College Education Level
As of the day before the first day of instruction of the term you are applying for, please indicate the highest college education level you attained:
Section I: Needs & Interests
Primary Language
Are you comfortable reading and writing English?
Are you interested in receiving information about money for college?
Are you receiving TANF/CalWORKs, SSI, or General Assistance?
Athletic Interest
Are you interested in participating in a sport while attending college?
(Your response does not obligate you in any way. To be eligible to participate on an intercollegiate team, you must be enrolled in at least 12 units.)
Yes, I am interested in one or more sports, including the possibility of playing on an intercollegiate team.
Yes, I am interested in intramural or club sports, but not in playing on an intercollegiate team.
No, I am not interested in participating in a sport (beyond taking P.E. classes).
Programs & Services: Select one or more programs and/or services you would like more information about.
No
Yes
No
Yes
No
Yes
Academic counseling/advising
Basic skills (reading, writing, math)
CalWorks
Career planning
Child care
Counseling - personal
DSPS Disabled Student Prgms & Svcs
EOPS Extended Opportunity Prgms & Svcs
ESL - English as a Second Language
Employment assistance
Online classes
Re-entry program (after 5 years out)
Scholarship information
Student government
Testing, assessment, orientation
Transfer information
Tutoring services
Veterans services
Year
College Degree Date
Date you obtained your highest degree.
Associate Degree
Month Day
47.
48.
49.
50.
51.
52.
Your Name: ______________________________
Obtained?
Colleges Attended
Print the names and locations of every college and university previously attended. Begin with the most recently attended institution. Attach
a separate sheet if more space is needed. Please complete each column as appropriate.
Y or N
Section H: Colleges Attended
Health services
Housing information
Page 8 of 10
Attendance From
Attendance To
Month
Month
YearYear
Need Help? OpenCCC Helpdesk: Call: 877-247-4836 Email: support@openccc.net
Financial Assistance
Revision 12.12.16
Revision 12.12.16
9
Your Name: ________________________________
I authorize the Chancellor's Office, California Community Colleges, and the community colleges I am attending, to release necessary personal
information
contained in my education records, including my Social Security Number, for the purposes described in the Full Statement of Consent.
Applicant's Legal Name
Signature
:
I consent
Submission of Application
All of the information in this application pertains to me.
All of the statements and information submitted in this admission application are true and correct.
I understand that falsification, withholding pertinent data, or failure to report changes in residency may result in District action.
The materials and information submitted by me for purposes of admission become the property of the College I am apply to.
I do not consent
Federal and state financial aid programs are available and may include aid in the form of grants, work study, and/or available student loans.
I am aware that I may apply for assistance for up to the total cost of my education including enrollment fees, books & supplies,
transportation, and room and board expense.
I may apply for financial assistance if I am enrolled in an eligible program of study (certificate, associate degree, or transfer), and may receive
aid if qualified, regardless of whether I am enrolled full-time or part-time.
By Checking here, I acknowledge understanding that:
Section K: Consent & Submit
The community colleges you attend and the Chancellor's Office of the California Community Colleges request your help. We ask that you agree to allow us to
release necessary personal information about you to various agencies and organizations so we can do research, plan programs and offer special services to
you (such as transfer opportunity information or state financial aid). If you do agree to give your consent, your information will not be sold, used for commercial
purposes, released to the public, or given to other government agencies for purposes of determining benefits (other than financial aid), except where
specifically required by law. In addition, if you do consent to release of your information, those organizations and agencies to which your information is given
are prohibited by law from using it for any unauthorized purpose or releasing it to anyone else. If you do not give your consent, personal information about you
will not be shared with other organizations or agencies except where allowed by law. You should also know that answering "no" to this question will not prevent
release of certain "directory information" about you.
Consent to Release Information
By checking here, I declare under penalty of perjury that:
__________________________________________________________________
________________________
Date
•
•
•
•
Section J: Financial Aid Acknowledgment
When submitting an application for admission to a California Community College, the college must obtain acknowledgment that the applicant
understands the financial aid opportunities that exist for CCC students. For more information about financial aid, see Appendix i (page 10).
Appendix i: Information Section
California Statewide Student Identifier (SSID) - Providing the ten digit Statewide Student Identifier or SSID is optional. The SSID allows individual student data to be uniquely distinguishable
from that of other students.The SSID may be indicated on your high school transcripts or other school documentation. If you don't know your SSID and would like to include it in this application, contact
your last public school or district office.
Section A: Enrollment & Account Information (Page 1)
Permanent & Current Address for Homeless Youth - State regulation (AB 801) allows for homeless youth to receive special residency consideration and eligibility for priority registration. If
you are currently homeless and have no permanent or current mailing address, check the box(es) in Section A, p.1, questions #5 and #6, and see the information pertaining to homeless youth in Section
E of Appendix i: Information Section, page 10, and submit verification to support your homeless status to the Admissions Office at the college to which you are applying.
53.
Page 9 of 10
Previous & Preferred Names -These fields are optional. Please provide any Previous name that may have been used on legal documentation or academic records in the past. If you choose to
provide a preferred name, note that not all colleges allow the use of preferred names for official academic uses due to legal or technical restrictions.
CCCApply Application for Admission
Revision 12.12.16
•
•
•
Appendix i: Information Section
Section B: Personal Information (Pages 2-3)
So
ci
al Security Numb
er (SSN)
-
(
Required to receive Finanical Aid) If you do not have a Social Security
Number
or Taxpayer ID
at the time you file th
is application, you may leave
the field
blank;
however, you should obtain a Social Security number, unless you are prohibited by law from doing so, and submit it to the college
by the
time you begin enrollment. Failure to
provide your correct
Social Security number may result in penalties levied against you
by the
IRS.
Gender, Transgender & Sexual Orientation - (Optional) Per state law (AB620) colleges are required to request voluntary demographic information regarding the sexual orientation, gender
identity, and gender expression of students. (California Education Code section 66027)."Transgender" is the state of one's gender identity (self-identification as woman, man, neither or both) not
matching one's
assigned sex (identification by others as male, female or intersex based on physical/genetic sex). "Sexual orientation" describes an enduring pattern of attraction-emotional, romantic,
sexual, or some combination of these-to persons of the opposite sex, the same sex, or to both sexes, as well as the genders that accompany them. "Gender Identity" means one's private sense of
being male or female. "Gender Expression" means a person's gender-related appearance and behavior, whether or not stereotypically associated with the person's assigned sex at birth.
Race/Ethnicity - (Optional) Per U.S. Department of Education guidelines, colleges are required to collect racial and ethnic data but are prohibited from discriminating against applicants on the basis
of race, color, or national origin in all programs or activities that receive Federal financial assistance. Ethnicity is sensitive information, protected by federal law and the Office of Civil Rights. It is used
primarily by agencies affiliated with state reporting and evaluation of educational programs.
Deferred Action for Childhood Arrivals (DACA) - If you have qualified for Deferred Action for Childhood Arrivals (DACA) from the United States Citizenship and Immigration Services and
subsequently been issued a Social Security Number, please enter the number on page 2.
Section C: Citizenship / DACA (Page 4)
Current and former U.S. military members, and their dependents (parent/guardian, spouse, or child), stationed in California, that declare California as their State of Legal Residence and/or Home of
Record, are eligible for California residency and other benefits. Your "State of legal residence" (also called "domicile") is the place you consider as your true, fixed, and permanent home. It is the state
to which you officially intend to return after your military service. "Home of record" is almost always the state where you first joined the military. "Home of record" and "State of legal residence" are
usually the same, because most people joining the military do so in the state that is their legal residence. However, "Home of record" and "State of legal residence" need not be the same.
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10
California Community Colleges are prohibited from using personal demographic information for discriminatory purposes as part of the admission process to their college. Many of the questions
in the Personal Information section are mandated by federal and state laws; furthermore, colleges are subject to policies and regulations regarding how they can collect, store, and use the data.
Dependency Status Determination (Minors) - For the purposes of determining residency, unlike in general law, a minor is defined as someone under 19 years of age. If you are a minor you
must answer this question (Section B, page 2, question #8) to determine if you are subject to care and control of a guardian. If you answer "Yes" to this question, you must provide information about
your Parent/Guardian in Section E: California Residency (on page 5) and where indicated throughout this application.
Parent: For the purposes of this college application, your parent is a natural or adoptive mother or father with whom you live and/or who provides your support, care, and
control. If you have two parents, you can enter the name of either one.
Guardian: For the purposes of this college application, your guardian is a person other than a parent who has been legally appointed to provide your support, care, and
control. If you have two guardians, you can enter the name of either one.
•
•
•
Section D: U.S Military Members & Dependents (Page 4)
Section E: California Residency (Page 5)
For the purposes of determining tuition, all students are classified for California residency at the time of application for admission. When determining the length of time lived continuously in
California, disregard absences from California for education, business, or vacation that did not affect your intent to maintain residency in California and did not involve activities as a resident of
another state.
Court-Ordered Foster Care - Current and former foster youth are eligible for residency consideration, as well as priority registration at all California Community Colleges (AB 12). You have been
in foster care if you were removed from your biological family through an order by a court, which can include placement with foster parents, in a group home, or with relatives/extended family
members. If you were living with relatives you must have been placed through the foster care system by an order of the court. Foster Care includes, but is not limited to, placement in out-of-home care
under the supervision of the Juvenile Probation Department. As long as you were placed within the foster care system by order of a court, you were in foster care. Having a legal guardian does not
necessarily mean that you have been in foster care. If you need assistance with determining whether you were in foster care, or when you exited from foster care, you can contact the California Foster
Care Ombudsman's office at (877) 846-1602 or fosteryouthhelp@dss.ca.gov.
Homeless Youth - State regulation (AB 801) allows for homeless youth to receive special residency consideration and eligibility for priority registration. If you are under age 25 and, at any time
within the last 24 months, have been determined to be homeless by a high school or school district counselor, emergency shelter or transitional housing program, or director of a runaway or homeless
youth basic center or transitional living program, you must submit verification of homeless status to the Admissions Office at the college to which you are applying.
Revision 12.12.16
Page 10 of 10
Section F: High School Education (Page 6)
Information about your last high school, secondary school, or registered homeschool, is required for the purpose of determining residency and tuition fees. If you plan to enroll in high school and
college at the same time, you may be required to submit permission from your high school Principal granting approval for concurrent enrollment. Please contact the college Admissions Office for more
information. Providing information in Section G: High School Transcript Information (page 7) is optional.
When submitting an application for admission to a California Community College, the college must obtain acknowledgment from the applicant that the applicant understands the
financial aid opportunities that exist for CCC students. This acknowledgement will be obtained using a checkbox field on the Submission page (page 9).
AB 540 and California Dream Act - Under California law AB 540, students who attended high school in California for three or more years and who graduated from a California high school
(or attained the equivalent) are exempt from paying nonresident supplemental tuition until they take steps to make California their permanent residence. See Admissions Office for more information.
Section J: Financial Aid Acknowledgement (Page 9)
Section K: Consent to Release (Page 9)
Need Help? OpenCCC Helpdesk: Call: 877-247-4836 Email: support@openccc.net
California Community Colleges and the CCC Chancellor's Office must obtain the consent of the applicant before using any data from an application for admission for other purposes such
as research and planning. In the CCCApply online application, consent is confirmed through electronic signature technology.
Discharge Type & Date - Members who served in the U.S. military, and their dependents, who were Not dishonorably discharged within three years of the day before the first day of instruction for
the term in which you are applying are eligible for residency consideration and should contact the Admissions Office for information on the required documentation of discharge.
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Form 1: C The California Community Colleges (Moorpark College)

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Completed 25 July 2020

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