Fillable MEOC Online Application (Columbia College)

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MEOC Online Application (Columbia College)

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The MEOC Online Application (Columbia College) form is 2 pages long and contains:

  • 2 signatures
  • 33 check-boxes
  • 62 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Columbia College (CA)

BROWSE COLUMBIA COLLEGE (CA) FORMS

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Motherlode Educational Opportunity Center (MEOC)
Participant Application
Student Information
First Name
MI
Last
Maiden
SSN
DOB (mm/dd/year)
Age
Address
Phone
Are you a U.S. Citizen?
If no, Alien Reg. #
Male/Female
Marital Status as of TODAY
Ethnicity (mark all that apply)
American Indian/Alaska Native Asian Black/African American Hispanic/Latino
Nati
ve Hawaiian/Pacific Islander White
Special Circumstances: (mark all that apply)
Homeless Disabled Learning Disability Offender/Ex-Offender Foster Youth
Are you a veteran?
Are you military connected?
If yes:
A
ctive Duty Spouse of Active Duty Child of Active Duty
Financial Information
Employment Status
Fu
ll-time Part-Time Unemployed Seasonal
Household Size
Income Source
Last year, what was your “taxable” income?
(Line 43 – Form 1040, Line 27 – Form 1040A, or Line 6 – Form 1040EZ)
Academic Information
Highest grade completed as of the date of this application: (select only one)
In H.S
. – Current Grade _______ H.S. Graduate H.S. Dropout (highest grade completed) ________
G
ED/Equivalency Adult w/o H.S. Credentials Adult w/o H.S. Credentials Currently Enrolled in GED Program
Cur
rently in College (select year completed) Freshman Sophomore Junior Senior
Col
lege Transfer College Drop
out A
ssociate’s Degree Bachelor’s Degree
Do you want to attend college or vocational training?
School/College Currently Attending
Enrolled Date
School/College Currently Attending
Enrolled Date
Did either of your parents complete a bachelor’s degree?
If yes, did you live with them?
Participant Needs Assessment
Mark all that apply:
Academic Guidance Admission Application Aged-Out Foster Information Budget Planning Career Exploration
Choosing a school/college Defaulted student loans Diploma/GED Disabled Student Services Financial Aid
Financial Literacy Health Services Housing Info Job Search Mental Health Scholarships
Study Skills Tutoring Transfer Assistance Veterans Services Vocational Training
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Additional Information
How did you hear about MEOC?
Where did you receive this application?
Are you receiving services from other community agencies?
If yes, where?
Are you receiving services from any of these programs? (check all that apply)
Upwar
d Bound (UB) Talent Search (TS) Student Support Services (SSS)
Specialized Service Requests/Notes:
Authorization
I declare under penalty of perjury that the information on this form is true to the best of my knowledge. Pursuant
to 20 USA 1231a of the U.S. Department of Education, MEOC is authorized to access information deemed
necessary to assist me in achieving my educational goals or in meeting the reporting requirements of the U.S.
Department of Education, to record pertinent facts regarding my eligibility in the program, services rendered, and
post-secondary education enrollment. This information is protected by the Privacy Act, kept confidential and not
to be seen unless specifically authorized. A copy of this statement shall serve as such authorization.
_____________________
Date
__________
___________
__________________________________________
Signature
__________________________________________
Parent signature (for dependents under 24)
Date
For Office Use Only
FG/LI LI Only FG Only Neither Cohort Year ___________ Military Connected: ________________
Status: Active Inactive Termination Date: _______________ Counselor: ____________________________________
College Ready: __________ Financial Aid Completion: __________ College Application Completed: ______________
Admitted School: ___________________________________ Postsecondary Status (enrolled/not enrolled): ______________________
There ar
e several ways to submit your MEOC application. If none of these options work for you, please contact us at 588-5066 and we will work with you to
find a way for you to submit it.
1. Scan and em
ail to: ColumbiaTrio@yosemite.edu
2. Fax to: 209-588-5058
3. Mail to: Columbia College
MEOC Office - Manzanita 212
11600 Columbia College Drive
Sonora, CA 95370
Version 1/24/17 msw/tl
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MEOC Online Application (Columbia College)

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Completed 18 July 2020

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