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Applicant's Information/Información del solicitante

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Personal/Education/Agreement/Overall Ratings Personal/educación/acuerdo/calificaciones totales

IMPORTANT: Checklist to complete before you applying to EOPS
IMPORTANTE: Complete la lista antes de aplicar a EOPS.

Before you apply, please make sure to complete all items below before submitting your application. (Incomplete application will not be processed)
Antes de aplicar, por favor asegúrese de completar todos los artículos a continuación antes de enviar su solicitud. (No se procesarán solicitudes incompletas)
IMPORTANT/IMPORTANTE:

Please note that meeting the eligibility requirements does not guarantee admission to the program/Tenga en cuenta que cumplir con los requisitos de elegibilidad no garantiza la admisión al programa.
Student Name/Nombre del estudiante * First Last
CCC Student ID#/Número de identificación del estudiante de CCC *
Maximum of 7 characters. Currently Used: 0 characters.
Student's date of birth/Fecha de nacimiento del estudiante * MM / DD / YYYY
Term Applying/Semestre para el cual está aplicando *
Have you completed 70 degree applicable units or have obtained an AA/AS/BA degree at any college or University?
¿Ha completado 70 unidades que sean aplicables a alguna licenciatura o ha obtenido un AA/AS/BA en alguna Universidad? *
Yes No
If you have attended another college, please upload transcripts from that college (s)/Si contesto si, favor de subir Programa de Estudio de otras universidades

Please upload transcripts from any other colleges or universities you have attended (not in our district)
Por favor, suba el Programa de Estudio de otros colegios o universidades a las que haya asistido (no en nuestro distrito)
Will you be enrolled in at least 12 units this semester?/¿Estará matriculad@ en al menos 12 unidades este semestre? *
Yes/Si No/No
Is this your first time applying to EOPS/Esta es la primera vez que aplica a EOPS? *
Yes/Si No/No

What is EOPS? EOPS is designed to help students who come from a disadvantaged backgrounds achieve their academic goals, whether it be earning a Certificate, Associate's Degree or transferring to a four-year university/¿Qué es EOPS? EOPS está diseñado para ayudar a los estudiantes que provienen de entornos desfavorecidos a lograr sus objetivos académicos, ya sea para obtener un Certificado, un Título de Asociado o la transferencia a una universidad de cuatro años.
Are you single head of household?/ es usted jef@ de hogar? *
Yes/Si No

What is EOPS? EOPS is designed to help students who come from a disadvantaged backgrounds achieve their academic goals, whether it be earning a Certificate, Associate's Degree or transferring to a four-year university/¿Qué es EOPS? EOPS está diseñado para ayudar a los estudiantes que provienen de entornos desfavorecidos a lograr sus objetivos académicos, ya sea para obtener un Certificado, un Título de Asociado o la transferencia a una universidad de cuatro años.
Marital Status/Estado Civil *
Single (Never Married)/Solter@ (Nunca ha sido casad@) Married/casad@ Divorced/Widowed/Divorciad@/Viud@ Separated/Separad@

What is EOPS? EOPS is designed to help students who come from a disadvantaged backgrounds achieve their academic goals, whether it be earning a Certificate, Associate's Degree or transferring to a four-year university/¿Qué es EOPS? EOPS está diseñado para ayudar a los estudiantes que provienen de entornos desfavorecidos a lograr sus objetivos académicos, ya sea para obtener un Certificado, un Título de Asociado o la transferencia a una universidad de cuatro años.
CARE Program/Programa de CARE *
NOT interested (I do not have a child or children)/NO estoy interesado(a) (no tengo hijos) YES, I am Interested (I am a single parent with children, receiving CalWORKs/TANF/SÍ, estoy interesad@ (soy un padre/madre solter@

What is CARE? CARE is a supplemental program to EOPS that is designed to provide extra help. If you are a single parent and currently receiving cash aid benefits from the County, you may be eligible for the CARE Program. Please ask the staff for more information.
¿Qué es el CARE? CARE es un programa suplementario para EOPS que está diseñado para proporcionar ayuda adicional. Si usted es un padre soltero y actualmente recibe beneficios de ayuda en efectivo del Condado, usted puede ser elegible para el programa de CARE. Por favor pregunte al personal para más información.
Have you even been in the Foster Care system at any point in time for any reason? *
No Yes Not Sure

The term Foster Care can include temporary or long-term placements with foster parents, family members, family friends, or other caring adults.

This could have been voluntary or court-ordered. This could have happened at any time in your life, for any reason.

- If this applies to you, please choose YES

- If you were never in any form of Foster Care placement, please choose NO.

- If for any reason you are not sure, please choose NOT SURE.

We can help you determine eligibility!
If yes, were you in Foster Care after your 13th birthday? *
No Yes Not Sure

Individuals that were placed in the Foster Care system, for any reason after their 13th birthday, may be eligible for additional programs, services, and resources to help pay for school.

- If this applies to you, please choose YES.

- If you were never in any form of Foster Care placement, please choose NO

- If for any reason you are not sure when you were in Foster Care, please choose NOT SURE.

We can help you determine eligibility!
If yes, were you in Foster Care at any point between the ages of 16-18? *
No Yes Not Sure

Individuals that were in a court-ordered Foster Care placement during this time period may be eligible for California’s Chafee Grant for Foster Youth.

- If this applies to you, please choose YES.

- If you were never in any form of Foster Care placement, please choose NO.

- If for any reason you are not sure when you were in Foster Care, please choose NOT SURE.

We can help you determine eligibility!
Have you ever been in the NextUp program at any California Community College? *
No Yes Not Sure

Individuals that previously participated in any NextUp program at any California Community College may be eligible to reenroll in the NextUp program at Contra Costa College.

- If this applies to you, please choose YES.

- If you were never in any form of Foster Care placement, please choose NO.

- If you are a former Foster Youth and you are not sure whether you were in a NextUp program at another California Community College, please choose NOT SURE.

We can help you determine eligibility!
Are you participating in any other program?
¿Está participando en algún otro programa? *
NONE /NINGUNO DSPS Dept. of Rehab Former Foster Youth CalWORKs Making Wave Veteran Gateway Promise Scholars Program Middle College HS HS Stem
College E-mail Address/Correo electrónico del colegio *

@insite.4cd.edu (example: jsmith123@insite.4cd.edu)
Alternate E-mail Address/Correo electrónico adicional

@gmail.com, @yahoo.com, etc. (example: jsmith123@gmail.com)
Best Phone Number to reach you
Número de teléfono donde podamos comunicarnos con usted * ### - ### - ####
Gender/Género *
Male/Hombre Female/Mujer Other/Otro
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Wufoo

IMPORTANT: Checklist to complete before you applying to EOPS IMPORTANTE: Complete la lista antes de aplicar a EOPS.

IMPORTANT/IMPORTANTE:

IMPORTANT: Checklist to complete before you applying to EOPS
IMPORTANTE: Complete la lista antes de aplicar a EOPS.