Revised August 2020
GAIN Services Worker Name:
GAIN Services Worker Phone:
GAIN Case Number:
Course Name & Number Description of Book Supplies
Ed Plan
Courses
Cost of Supplies Fees
Only for Spring and Fall Semesters Health Fee
ASB Sticker
Only for Spring and Fall Semesters
Basic school supplies - $60.00 (tax included)
Example: Math 23/ 9250
3rd Edition - Pre Algebra
Sub-total by category:
Tax:
Total of each category:
You will need to provide original Receipts to your GSW 10 days after funding.
(Include your class SYLLABUS as well).
The decision to either approve or deny requests for anything other than what is required is left to DPSS.
ECC
CalWORKs staff signature does not guarantee that your entire request will be approved.
74.95
Overall Total of
this request:
Some books were
not purchased at the El Camino College Bookstore.
GAIN Student Signature:____________________________________ Date: ________________ CalWORKs Staff:_______________________________________ Date:_________________
Cost of Book
The El Camino Community College District is committed to providing an educational and employment environment in which no person is subjected to discrimination on the basis of actual or perceived race, color, ancestry, national origin, religion, creed, age (over 40), disability (mental or physical),
sex, gender (including pregnancy and childbirth), sexual orientation, gender identity, gender expression, medical condition, genetic information, marital status, military and veteran status, or retaliation; or on any other basis as required by state and federal law.
*This form will not be accepted without a current class schedule*
REQUIRED EDUCATIONAL MATERIALS FORM
SEMESTER: Winter ____ Spring ____ Summer ____ Fall ____ Year ________
Click to go to the online
ECC Bookstore
Student ID#
Phone #
Student Name
Email completed form to calworksinfo@elcamino.edu
