Fillable I. Applicant Information Fall Spring Name Address Primary (West Los Angeles College)

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I. Applicant Information Fall Spring Name Address Primary (West Los Angeles College)

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Contact #
Address
member receiving:
Office SSB-330
Telephone: (310) 287-4317
I.
Applicant Information
Student ID Application Term:
❑Fall ❑Spring
Name
Last First Middle
Address
Street
City State Zip Code
Primary
Alternate #
College Email
@student.laccd.edu
Date of Birth
Personal
Email Address
❑Female
Citizenship ❑ U.S. Citizen
(MM/DD/YY)
Gender
❑ Male Status ❑ Non-Citizen
❑ African American/ ❑ Asian American/ ❑Latin American/ ❑Other:
Ethnicity
Black Asian Hispanic
❑American Indian/
Alaskan Native
❑Caucasian/White ❑Pacific Islander ❑Decline to State
II.
Student Educational Background
Did you receive a: Please answer the following:
❑ High School Diploma
❑ G.E.D.
❑ High School Equivalency
❑ No High School Diploma
Are your assessment scores
below:
Are you a current or former foster youth? ❑Yes ❑No
Was your High School G.P.A. below 2.5? ❑Yes ❑No
Have you ever been enrolled in remedial courses? ❑Yes ❑No
Are your parents native English speakers? ❑Yes ❑No
Did either of your parents receive a U.S. College degree? ❑Yes ❑No
Have you ever attended another college? ❑Yes ❑No
If YES, which college(s) *
*Please attach unofficial transcripts of ALL colleges attended to your EOPS application.
English 101 ❑ Yes ❑ No What are your college goals? (CHECK ALL THAT APPLY)
Math 125/123C
❑ Yes ❑ No ❑Certificate of Completion ❑ AA/AS Degree ❑ University Transfer
III.
EOPS Criteria IV. Board of Governors Grant Criteria
Are you a resident of
❑ Yes ❑ No
California
Have you completed 70+
❑ Yes ❑ No
degree applicable units?
Do you have an AA/AS,
❑ Yes ❑ No
BA/BS or higher degree?
Are you or any family
❑CalWORKs ❑TANF
Number of members in family
(including yourself)
Last year’s family annual
income
V. For Foster Youth Only VI. Student Certification
Are you a current or former foster youth whose
dependency was established on or after your 13
th
birthday? ❑Yes ❑No
I certify that the statements on this application are accurate to the
best of my knowledge.
Are you 25 years or younger? ❑Yes
❑No
_________________________________________________________
Student Signature
_________________________________
Date Application was submitted
Application Received By:
Staff Initial: Date:
NOTE: All applicants must have applied for a fee waiver (BOGG) through the Financial Aid office and be enrolled in 12 units
before submitting the application.
$
Orientation
❑Scheduled EOPS Orientation
Date: / /
Time: : am/pm- : am/pm
Date
Comments
Initials
Contacted student to let him/her know he/she was: ❑Approved ❑Denied
Contacted: ❑By Telephone ❑Left Voicemail ❑Email ❑In Person
Student ID
Foster Youth
Cash Aid
BOG
CA Resident
Educationally Disadvantaged
Units Enrolled
Total Degree Units Completed
AA or higher
Home School
Application Status
****FOR OFFICE USE ONLY****
Application Reprocess
❑Submitted Application to be Reprocessed
Date: / /
Reason: ❑Enrolled in 12 units ❑Submitted transcripts ❑Processed Fee Waiver ❑Other:
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I. Applicant Information Fall Spring Name Address Primary (West Los Angeles College)

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Completed 17 February 2022

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