Submit Your Application

Thank you for applying to SJCC EOPS.

To prevent any delays in the eligibility process, please complete the entire EOP&S application.

If a question does not pertain to you, please do not leave it blank. Write/or select N/A.

General Information:

*

Today's Date:

When entering your SJCC Student ID (SID), ONLY enter the numbers, not the zeros on the left.
Example: SJCC SID 086937, Enter 86937

SJCC Student ID (SID): *

Last Name: *

First Name: *

Middle Name:

Home Phone:

Cell Phone Number: *

Email Address: *

Date of Birth: *

Address: *

City: *

State: *

Zip: *

Gender:

If you do not identify with the F or M gender listed above, please enter the gender you identify with below.

Ethnic Background:

Marital Status: (M) Married, (S) Single. For other status, select below:

Academic Information:

CA Resident or AB540 *

Had IEP or 504 Accommodations in HS? *

Did you graduate from High School (HS): *

If HS Graduate, HS Name:

Attended another college besides EVC? Y/N *

Please attach your transcripts for the institution (s) listed above.

If Y, Name of Other Institutions Attended

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Support Services Information:

Have you ever been in the EOP&S program at any college? *

Did either of your parents receive a Bachelor’s degree in the U.S? If YES, Please check, if NO, skip

Are you currently receiving benefits from any of the following *

Children under the age of 18? If Yes, enter the number of children under 18

Have you ever been in Foster Care? If YES, Please check, if NO, skip

If you have been in Foster Care, please upload Dependency letter

Are you currently enrolled in any of the following SJCC programs: ALMASS, CalWORKs, Guardian, METAS, Puente, SAS, Umoja, Veterans, Other (please specify), None.
List ALL programs.

*

This application will be used to determine EOP&S eligibility. All information on this form will be kept confidential. By signing this application you authorize the EOP&S staff to release and/or share information with other college programs/services needed to determine your eligibility.

Sign and Submit:

Applicant Signature

Please select a signature verification type.