Fillable LMC EOP Sonlineapplication (Los Medanos College)

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LMC EOP Sonlineapplication (Los Medanos College)

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Los Medanos College
Extended Opportunity Programs and Services (EOPS)
2700 Leland Road, Pittsburg, California 94565-5197 (925) 439-2181 x3138 Fax: (925) 427-1599
I. APPLICANT INFORMATION
II. ETHNIC BACKGROUND
Student ID#
City
State
Zip Code
E-mail Address
Phone #
Lastname
Firstname
MI
Marital Status
Ethnicity:
What is your primary language?
Address
Apt.#
MM/DD/YYYY
Language:
TERM APPLYING:
Gender
Specify (if asked)
Date of Birth
Student ID# is required to proceed. If you do not have a student ID#, please apply with the admission & reocords office.
III. EDUCATIONAL BACKGROUND
Student Academic History:
o
High School:
Received:
GPA
Year:
o
College:
Type:
Do you hold any college degrees/certificates?
Please list ALL colleges you have attended below:
College or University
City
State
Units
Dates
GPA
NOTE: Please provide official copies of your academic transcripts for all colleges attended to the Admissions and
Records Office or an unofficial copy to the EOPS Office.
Text
IV. EDUCATIONAL GOAL
What is your training/educational goal:
College or University
College or University
City
City
State
State
Dates
Dates
Units
Units
GPA
GPA
Parent(s) Academic History:
Years of College:
Years of College:
Where:
Where:
Degree
Degree
Mother -
Father -
Have you completed the 2006-07 FAFSA Application?
Are you (or your child) currently receiving TANF/CALWORKS?
Certification:
By submitting this document to the Los Medanos College, EOPS Office, you are certifying that all information
provided in this application is true and complete to the best of your knowledge. Any false statements or
failure to provide proof when required may result in denial or ineligibility to the program. Further, you are
authorizing EOPS/CARE staff to verify any and all information provided and exchange such information with
necessary offices/program s
If you are having difficulty submitting your EOPS application electronically, your computer system might not have the required reader to submit
your application online. Please print your application and submit it to the EOPS Office (RM 435) for processing. We apologize for the inconvenience.
Statement and Requirements Agreement
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LMC EOP Sonlineapplication (Los Medanos College)

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Completed 18 July 2020

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