Contact Information Student ID? First Name Middle Name Last Name Street Address City State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Primary Email Address Home Phone Cell Phone I give permission to receive EOPS related text messages at the above cell phone number Yes No Demographics Date of Birth Age Ethnic Background Ethnic Background - Select -American IndianAsianBlackFilipinoHispanic/ChicanoPacific IslanderWhite/AngloOther… Enter other… Marital Status - Select -SingleMarriedDivorcedSeparated Previous Year Total Family Income Please check all that apply to you Documentation will be needed to determine eligibility for EOPS I am enrolled or plan to enroll full time (12+units) at Ventura College I do not qualify for intermediate algebra (Math 3) or higher by testing I did not graduate from high school or obtain an equivalency or GED I do not qualify for English Composition (Engl 1A) I have not completed more than 50 units of degree-applicable credit I graduated from high school with a grade point average lower than 2.50 on a 4.0 scale I have been in a high school or college remedial education class I am an emancipated foster youth I am an AB540 student I am a Homeless Youth What is the highest level of education completed by your Mother? - Select -Didn’t Graduate High SchoolHigh School GraduateAA/AS DegreeBA DegreeGraduate Degree What is the highest level of education completed by your Father? - Select -Didn’t Graduate High SchoolHigh School GraduateAA/AS DegreeBA DegreeGraduate Degree Primary language spoken in my parents home is High School High School Background - Select -High School diplomaGED/ProficiencyForeign School diplomaNot High School Graduate Name of High School Last Attended/Graduation Date High School Grade Point Average College Enrollment Status - Select -First-time Student at Any CollegeFirst-time Transfer Student - attended another college, now at VCContinuing Student at this CollegeContinuing Student with Concurrent Enrollment at another collegeReturning Student – had a break in enrollmentReturning Transfer Student – attended VC, transferred, returned Educational Goal at VC Educational Goal at VC - Select -Transfer with AA/ASTransfer without AA/ASVocational AA/ASJob SkillsCertificateOther… Enter other… Major Total Units Completed Colleges Attended Prior College Degrees/Certificates Earned Residency Residency: Have you lived in California at least one year and one day? Yes No Place of Birth To assist you in your admission to the college: Are you a U.S. citizen? Yes No You have indicated that you are not a U.S. citizen. Do you or your parents have an alien registration/temporary resident/amnesty card or other INS documents? Yes No CalWORKs CalWORKs students must complete this section. (Only complete this section if YOU, the student, are a CalWORKs recipient receiving Cash Aid. This does not include those whose family members are receiving cash aid through CalWORKs.) I currently Receive TANF/CalWORKs I am a single parent Family Size # of children under 18 Photo Release I give permission to EOPS to take and use photos / videos of me in publications and in any other communications related to EOPS Yes No Signature I certify that the above statements are true and I will supply any documents needed to determine eligibility, and I give permission to review high school and/or college records Enter Your Full Name How did you hear about EOPS? How did you hear about EOPS? - Select -Received a Call from EOPSReceived an Email from EOPSFinancial AidGeneral CounselingEACStudent ConnectInstructorFellow StudentFamily MemberSocial MediaOther… Enter other… CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
