Oct 2025 AIAN Student Model Intake Form Survey

The California Community Colleges’ ICanGoToCollege.com campaign is seeking American Indian/Alaska Native (AIAN) students to represent AIAN student success in an upcoming media productions.

This opportunity is a statewide photo & B-roll shoot occurring in late January-February on various California community college campuses (exact dates and locations TBD). You will only be needed for a single day for up to four hours. Participants will be selected across age groups (18–24, 35–50) and diverse backgrounds, including career education students, active-duty military, veterans, foster youth, and student parents. Each participant will receive a $585 stipend plus travel reimbursement. Deadline to submit for this opportunity is Monday, January 5th.

Submission Deadlines: Surveys submitted by January 5 will be considered for this opportunity.

Please complete this brief survey to share your information and indicate your interest. Selected participants will be contacted with further details.

Full Name (First, Last)

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Date of Birth:

Gender:

Gender Pronoun:

Are you an enrolled tribal member? Input federally recognized or unrecognized tribe.

Are you a descendant, who was your last known enrolled tribal ancestor?

If none of the above is applicable, provide a paragraph below explaining your tribal affiliation and connectivity to culture and community.

Veteran

Active-Duty Military

Current or Former Foster Youth

Career Education

Student Parent

None of the Above

Yes

If yes, which one? Write in program:

Yes

Please specify which college you plan on transferring to (if applicable):

0-2 years old

3-6 years old

7-10 years old

11-14 years old

15-18 years old

Oct 2025 AIAN Student Model Intake Form

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* 1. Contact Information

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* 2. Best Way to Reach You (check al that apply)

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* 3. Additional Information:

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* 4. Tribal Affiliation:

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* 5. Name of Community College attending or attended or High School attending.

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* 6. Check all that apply.

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* 7. Are you currently enrolled in a Career Education program (i.e. automative technology, computer programming, etc.)?

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* 8. Do you plan on transferring to a four-year college or university? If yes, what four-year college do you plan on transferring to?

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* 9. Have you received/or will you receive financial aid to help pay for college?

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* 10. Are you available at short notice?

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* 11. Are you willing to sign a photo release form that acknowledges the California Community Colleges own the use of the photos for up to five years? A parental/guardian release form for children under 18 will be required.

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* 12. If you are a parent with a child, are you willing to appear in a photoshoot with your child(ren)?

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* 13. If yes, what is the current age of your child(ren) you would recommend participate in the photo shoot (check all that apply)?

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* 14. Tell us a little about yourself and your experiences at a California community college. Why do you think you would be the perfect candidate to represent your community college and the California Community Colleges system in 100 words or less?

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* 15. Provide your social media account handles. (Example: Instagram: @caiiff; FB: @caiiff)

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* 16. Attach a headshot. (No sunglasses or hats.)

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* 17. If you are a parent who is interested in participating with your child, please include a recent photo of you with your child.